Invega (Paliperidone) Initiation Timing
For oral paliperidone extended-release (Invega), initiate treatment at 6 mg once daily in the morning on day 1, with no titration required. 1, 2
Oral Paliperidone Extended-Release Dosing
Standard Initiation
- Start 6 mg once daily in the morning on the first day of treatment 1, 2
- No initial dose titration is necessary 1
- Peak plasma concentrations occur approximately 24 hours after dosing 1
- Maximum recommended dose is 12 mg/day 1
Special Population Adjustments
- Patients with mild renal impairment (CrCL 50-80 mL/min): Reduce initial dose 3
- Elderly patients with normal renal function: Use standard adult dosing (6 mg/day) 3
- Elderly with age-related decline in renal function: Adjust dose based on creatinine clearance 3
- Hepatic impairment (mild to moderate): No dose adjustment required 3
Clinical Context
The 6 mg starting dose represents a therapeutic dose that can be maintained without titration, distinguishing paliperidone from many other antipsychotics 1. Higher doses (up to 12 mg/day) may provide additional benefit but also increase dose-related adverse reactions 1. The extended-release formulation's osmotic delivery system allows immediate therapeutic dosing without the gradual titration typically required with immediate-release antipsychotics 2.
Common Pitfall to Avoid
Do not delay treatment waiting to titrate up from a lower dose - unlike many antipsychotics, paliperidone ER is designed to start at the therapeutic dose of 6 mg on day 1 1, 2. The extended-release formulation minimizes the antidopaminergic effects that would necessitate gradual titration with immediate-release formulations 2.
Assessment Timeline
Following the general principle for antipsychotic treatment, assess therapeutic response after 4 weeks of treatment at an adequate dose 4. Antipsychotic effects typically become apparent after 1-2 weeks 5. If significant positive symptoms persist after 4 weeks at therapeutic dose with good adherence, consider switching to an alternative antipsychotic 4.