paliperidone palmitate (Invega Trinza): Side Effects & Dosage

What is paliperidone palmitate? What is paliperidone palmitate used for?

Invega trinza (paliperidone palmitate) is an
atypical antipsychotic used to treat schizophrenia. It is a longer acting form
of Invega sustenna and Invega. Other atypical antipsychotic drugs include
olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), asenapine
(Saphris), iloperidone (Fanapt) and aripiprazole (Abilify).

Atypical antipsychotics differ from typical antipsychotics because they cause
a lesser degree of movement (extrapyramidal) side effects and constipation.

The exact mechanism of action of paliperidone is not known, but, like other
anti-psychotics, it is believed that paliperidone affects the way the brain
works by interfering with communication among the brain's nerves. Nerves
communicate with each other by making and releasing chemicals called
neurotransmitters. The neurotransmitters travel to other nearby nerves where
they attach to receptors on the nerves. The attachment of the neurotransmitters
either stimulates or inhibits the function of the nearby nerves. Paliperidone
blocks several of the receptors on nerves including dopamine type 2, serotonin
type 2, and alpha 2 adrenergic receptors. It is believed that many psychotic
illnesses are caused by abnormal communication among nerves in the brain and
that by altering communication through neurotransmitters, paliperidone can alter
the psychotic state. Invega trinza was approved by the FDA in May 2015.

What brand names are available for paliperidone palmitate?

Invega Trinza

Is paliperidone palmitate available as a generic drug?

No

Do I need a prescription for paliperidone palmitate?

Yes

What are the side effects of paliperidone palmitate?

The most common side effects include

• injection site reaction,
• weight gain,
• headache,
• upper respiratory tract infection,
• feeling restlessness
  or difficulty sitting still,
• stiffness and shuffling walk,
• tremors, and
• slow
  movements.

Less common but serious side effects are increased risk of stroke in elderly patients
with dementia-related psychosis.

Neuroleptic malignant syndrome or NMS is
a rare but serious side effect associated with the use of antipsychotics. Neuroleptic malignant syndrome
may result in death and must be treated in the hospital. Signs and symptoms of
heuroleptic malignant syndrome may include

• high fever,
• sweating (diaphoresis),
• severe muscle stiffness or
  rigidity,
• confusion,
• loss of consciousness,
• high blood pressure,
• rapid
  heartbeat, and
• changes in breathing breathing.

Extrapyramidal side effects include:

• Dystonia
  are painful spasms of the oral, throat, or
  neck muscles that may cause problems with speech, swallowing, and
  stiff neck.
• Akathisia are feelings of restlessness or difficulty
  sitting still.
• Pseudoparkinsonism is drug induced Parkinson’s
  symptoms.
• Tardive dyskinesia usually occurs
  after long term use of antipsychotics and usually presents with movement
  problems affecting the tongue, lips, jaw, face, and extremities.
• Metabolic changes including high blood sugar
  (hyperglycemia), diabetes mellitus, increase in blood cholesterol, and weight
  gain.
• High blood levels of prolactin. Prolactin is
  a hormone that allows the production of breast milk. High levels of prolactin
  may cause menstrual abnormalities, leakage of milk from the breast, development
  of breasts in males (gynecomastia), and erection problems in men.
• Seizures

Schizophrenia is the most disabling mental illness.
See Answer

What is the dosage for paliperidone palmitate?

• Invega trinza is administered once every 3 months by a health-care
  professional.
• Invega trinza is injected intramuscularly (into the muscle) in the
  upper arm or upper buttocks.
• The initial starting dose of Invega trinza is based on the last dose of
  Invega sustenna used.
  • If the last dose of Invega Sustenna is 78 mg; start Invega Trinza at
    273 mg
  • If the last dose of Invega Sustenna is 117 mg; start 410 Invega
    Trinza at mg
  • If the last dose of Invega Sustenna is 156 mg; start 546 Invega
    Trinza at mg
  • If the last dose of Invega Sustenna is 234 mg; start 819 Invega
    Trinza at mg

Which drugs or supplements interact with paliperidone palmitate?

Invega trinza can cause low blood pressure especially when standing up from a
sitting down or laying down position (orthostatic hypotension). Therefore,
Invega trinza should be used cautiously with other drugs also associated with
causing orthostatic hypotension.

Paliperidone is metabolized or broken down by liver enzymes. Drugs that
induce these enzymes will increase their activity and consequently decrease
blood levels of paliperidone. Paliperidone should not be taken with
carbamazepine (Tegretol), phenytoin (Dilantin), rifampin (Rifadin), St. John’s
Wort, and other drugs that may decrease its blood levels.

Paliperidone blocks the effect of dopamine in the brain while dopamine
agonists such as levodopa (Sinemet) increase the levels of dopamine in the
brain. Combining these agents is not recommended since the effect of both drugs
will be reduced.

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Is paliperidone palmitate safe to take if I’m pregnant or breastfeeding?

Fetuses exposed to antipsychotics during the third trimester of
pregnancy are at risk for extrapyramidal and withdrawal symptoms after birth.
Symptoms reported included agitation, hypertonia, hypotonia, tremor, somnolence,
depressed breathing, and feeding disorder. Currently there is no data on the use
of Invega trinza during pregnancy. Invega trinza should only be used during
pregnancy if the potential benefit to the mother outweighs the potential for
side effects in the fetus.

A pregnancy exposure registry has been established to monitor the use of
atypical antipsychotics, including Invega trinza, during pregnancy. All pregnant
women treated with atypical antipsychotics are advised to enroll in this
pregnancy registry and report any side effects.

Invega trinza is known to enter human milk but its effects
on the breastfeeding infant or milk production is not yet known.

What else should I know about paliperidone palmitate?

What preparations of paliperidone palmitate are available?

Extended-release injectable suspension: 273, 410, 546, or 819 mg

How should I keep paliperidone palmitate stored?

Invega trinza should be stored at room temperature between 15 C to
30 C (59 F and 86 F).