Invega Sustenna 225mg Dose Does Not Exist
The 225mg dose of Invega Sustenna (paliperidone palmitate) does not exist as a commercially available formulation, and this appears to be an error or miscommunication that requires immediate clarification with the prescriber.
Available Invega Sustenna Formulations
The FDA-approved doses of Invega Sustenna are:
- 39 mg, 78 mg, 117 mg, 156 mg, and 234 mg 1, 2
- The recommended dose range for oral paliperidone ER is 3-12 mg per day 1, 2
- For the long-acting injectable (Invega Sustenna), standard maintenance dosing ranges from 39-234 mg monthly 3
Critical Action Required
If a prescription states "225mg," this requires immediate verification:
- The closest available dose is 234 mg, which may have been the intended prescription 2
- Alternatively, this could be a confusion with oral paliperidone ER dosing (though 225mg would still be far above the maximum oral dose of 12 mg/day) 1, 4
- Contact the prescriber immediately to clarify the intended dose before dispensing
Standard Dosing for Invega Sustenna
Initial dosing protocol:
- Day 1: 234 mg deltoid injection 3
- Day 8: 156 mg deltoid injection 3
- Monthly maintenance: 117 mg (range 39-234 mg) can be administered deltoid or gluteal 3, 2
Dose adjustments should be based on:
- Clinical response and tolerability 2
- Previous oral risperidone or paliperidone dose (patients on ≥4 mg/day oral risperidone may require bridging therapy for ≥7 days after first injection to prevent inadequate serum concentrations) 3
- Renal function (dose reduction required in renal impairment, as 59% is eliminated unchanged through kidneys) 2, 4
Common Pitfalls to Avoid
- Never assume a non-standard dose is correct without verification, as medication errors with long-acting injectables can result in prolonged adverse effects given the 23-hour terminal half-life and sustained release formulation 4
- Failing to bridge patients switching from oral risperidone ≥4 mg/day is associated with increased hospitalization days 3
- Overlooking renal function before dosing, as paliperidone's primary elimination route is renal and dose adjustments are mandatory in renal impairment 2, 4