From the Research
For patients receiving monthly Invega (paliperidone palmitate) depot injections, a creatinine clearance (CrCl) of at least 50 mL/min is generally recommended as the lowest safe renal function threshold, as supported by the most recent and highest quality study available 1.
Key Considerations
- Patients with mild renal impairment (CrCl 50-80 mL/min) can typically receive the standard dose, but those with moderate to severe renal impairment (CrCl <50 mL/min) require dose adjustments or consideration of alternative medications.
- The recommendation exists because paliperidone is primarily eliminated by the kidneys, and impaired renal function leads to higher blood levels of the medication, increasing the risk of side effects.
- For patients with CrCl between 10-50 mL/min, the dose should be reduced by 25-50% of the standard dose, and careful monitoring is essential.
- Patients with CrCl below 10 mL/min should generally avoid Invega depot injections altogether.
Renal Function Assessment
- Before initiating treatment, a baseline renal function assessment should be performed, with regular monitoring throughout treatment, especially in elderly patients or those with risk factors for renal impairment.
- The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is a more accurate method for estimating glomerular filtration rate (GFR) compared to the Cockcroft-Gault formula, as highlighted in a recent study 1.
Monitoring and Dose Adjustments
- Regular monitoring of renal function and careful dose adjustments are crucial to minimize the risk of side effects and ensure the safe use of Invega depot injections in patients with renal impairment.
- The use of albuminuria in addition to GFR for CKD diagnosis and management is also recommended, as suggested by a recent study 1.