Therapeutic Dose of Invega (Paliperidone)
For adults with schizophrenia, start Invega at 6 mg once daily without titration, which is the recommended therapeutic dose; some patients may benefit from 3-12 mg/day based on response and tolerability. 1
Adult Dosing for Schizophrenia
The FDA-approved starting and recommended therapeutic dose is 6 mg administered once daily, with no initial titration required. 1
The therapeutic dose range is 3-12 mg/day, with 12 mg/day being the maximum recommended dose. 1
Although doses above 6 mg have not been systematically proven to provide additional benefit, there is a general trend for greater effects with higher doses, which must be weighed against dose-related increases in adverse reactions. 1
Some patients may benefit from a lower dose of 3 mg/day if 6 mg provides sufficient clinical stability. 1
When dose increases above 6 mg/day are indicated, make increments of 3 mg/day only after clinical reassessment, and generally at intervals of more than 5 days. 1
Adolescent Dosing (Ages 12-17)
Start at 3 mg once daily without initial titration. 1
Dose increases should be made only after clinical reassessment, at increments of 3 mg/day at intervals of more than 5 days. 1
In adolescent trials, there was no clear enhancement to efficacy at higher doses (6 mg for patients <51 kg; 12 mg for patients ≥51 kg), while adverse events were dose-related. 1, 2
Schizoaffective Disorder Dosing
The recommended dose is 6 mg once daily without initial titration, with a therapeutic range of 3-12 mg/day. 1
Dose increases, if indicated, should occur at intervals of more than 4 days in increments of 3 mg/day. 1
Renal Impairment Adjustments
For mild renal impairment (CrCl 50-79 mL/min): Start at 3 mg once daily, with a maximum of 6 mg/day based on response and tolerability. 1
For moderate to severe renal impairment (CrCl 10-49 mL/min): Start at 1.5 mg once daily (the FDA label text is cut off but indicates lower dosing). 1
Administration and Monitoring
Invega can be taken with or without food and must be swallowed whole—never chewed, divided, or crushed. 1
Assess efficacy after 4 weeks at a therapeutic dose with documented adherence before considering treatment failure. 3
Clinical response should be evident by 4 days to 4 weeks, with significant improvements in PANSS total scores demonstrated in clinical trials. 4, 5
Critical Warnings
Do not coadminister with risperidone without considering additive paliperidone exposure, as paliperidone is risperidone's major active metabolite. 1
Common adverse events include extrapyramidal symptoms (especially at higher doses), hyperprolactinemia, tachycardia, somnolence, and weight gain. 4, 5, 6
Extrapyramidal symptoms occurred in approximately 25% of patients at higher doses (9-12 mg/day) in clinical trials. 4