What is the recommended starting dose of Invega (paliperidone)?

Recommended Starting Dose of Invega (Paliperidone)

The recommended starting dose of Invega (paliperidone) extended-release tablets for adults with schizophrenia is 6 mg administered once daily. 1

Dosing Guidelines

Adult Patients

• Initial dose: 6 mg once daily
• No initial titration required
• Dose range: 3-12 mg once daily
• Maximum recommended dose: 12 mg once daily
• Dose increases: When indicated, increments of 3 mg/day are recommended
• Administration: Can be taken with or without food; tablets must be swallowed whole with liquids and should not be chewed, divided, or crushed 1

Special Populations

Renal Impairment

• Mild impairment (CrCl 50-80 mL/min): 3 mg once daily initially, maximum 6 mg once daily
• Moderate to severe impairment (CrCl 10-50 mL/min): 1.5 mg once daily initially, maximum 3 mg once daily
• Not recommended for patients with CrCl below 10 mL/min 1

Hepatic Impairment

• Mild to moderate impairment: No dose adjustment needed
• Severe impairment: Not studied, use with caution 1

Elderly Patients

• Same dosing as younger adults if normal renal function
• Adjust dose according to renal function status if impaired 1

Adolescents (12-17 years)

• Initial dose: 3 mg once daily
• No initial titration required
• Dose increases: If necessary, in increments of 3 mg/day at intervals of more than 5 days
• Note: Higher doses (6 mg for patients <51 kg and 12 mg for patients ≥51 kg) did not show clear enhancement of efficacy but had more adverse events 1

Clinical Considerations

Efficacy and Monitoring

• Paliperidone ER has been shown to be effective in treating schizophrenia and schizoaffective disorder 2
• Prescribe at the lowest effective dose for maintaining clinical stability
• Periodically reevaluate the long-term usefulness of the medication 1
• For maintenance therapy, paliperidone has been shown to be effective in delaying time to relapse in patients with schizophrenia who were stabilized for 6 weeks 1

Side Effects and Precautions

• Common side effects include extrapyramidal symptoms, tachycardia, and somnolence 2
• Incidence of Parkinsonism, akathisia, and use of anticholinergic medications increases in a dose-related manner 2
• QTc interval prolongation may occur but typically does not produce clinical symptoms 2
• Increases in serum prolactin levels may occur 2

Switching from Other Antipsychotics

• Paliperidone is the active metabolite of risperidone
• When switching from oral antipsychotics, paliperidone ER can be initiated the day after discontinuing previous treatment 3
• Paliperidone's route of metabolism and elimination differs from risperidone, which may be advantageous in patients with liver disease or drug-drug interactions 4

Important Clinical Pearls

• No oral supplementation is required when initiating treatment 3
• The pharmacokinetic profile results in more stable serum concentration 2
• Undergoes limited hepatic metabolism, minimizing the risk of hepatic drug-drug and drug-disease interactions 2
• The OROS® delivery system allows for once-daily dosing 2

Remember that the appropriate dose should be determined based on clinical response and tolerability, with the goal of using the lowest effective dose to minimize side effects while maintaining symptom control.