Paliperidone

INVEGA

Open Paliperidone in the interactive console ↗

Pronunciation: pal-ee-PER-i-doen (in-VAY-ga)

Paliperidone ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Paliperidone ballicule

Paliperidone INVEGA mascot mnemonic cartoon — Visual mnemonic: Paliperidone mascot
**“Pale lips In Vegas”**
Spooky mascot → antipsychotic
Variation of risperidone Frankenstein mascot → paliperidone is active metabolite

What it isD2 and 5-HT2A antagonist and active risperidone metabolite; schizophrenia and schizoaffective disorder.

Why it mattersIts long-acting injections offer the longest maintenance intervals available in psychiatry.

What it changesRenal clearance requires dose adjustment in CKD. Prolactin elevation, EPS, and QT prolongation can end treatment.

Paliperidone molecular structure (skeletal formula) — Molecular structure: Paliperidone

FDA-approved for

schizophrenia (2006)
schizoaffective disorder (2009)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Increased mortality in elderly patients with dementia-related psychosis; not approved for dementia-related psychosis.

FDA dosing	Population	Start	Target	Max
Schizophrenia	Adults	6 mg QD	3–12 mg QD	12 mg QD
Schizophrenia	Adolescents 12–17 yr	3 mg QD	3–12 mg QD (wt-dependent)	6 mg (<51 kg) / 12 mg (≥51 kg) QD
Schizoaffective disorder	Adults	6 mg QD	3–12 mg QD	12 mg QD

Titration >5 days between increases (>4 days for schizoaffective); 3 mg/day increments

Renal Mild (CrCl 50–<80): start 3 mg QD, max 6 mg QD. Moderate–severe (CrCl 10–<50): 3 mg QOD or 1.5 mg QD, max 3 mg QD. CrCl <10: not recommended.

Hepatic Mild–moderate (Child-Pugh A/B): no adjustment. Severe: not studied.

Instructions

Swallow tablet whole with liquid; do not chew, divide, or crush
Take with or without food

Available strengths

ER tab 1.5, 3, 6, 9 mg

Cautions

Increased mortality/cerebrovascular reactions in elderly dementia patients
Neuroleptic malignant syndrome
QT prolongation — avoid with other QT-prolonging drugs
Tardive dyskinesia
Metabolic changes: hyperglycemia, dyslipidemia, weight gain
Hyperprolactinemia
Orthostatic hypotension and syncope
Leukopenia, neutropenia, agranulocytosis
Seizures
GI narrowing/obstruction (non-deformable ER shell)
Cognitive/motor impairment

Adverse reactions

EPS, akathisia, tachycardia
Somnolence
Adolescents: tremor, dystonia, cogwheel rigidity, anxiety, weight increased
Schizoaffective: dyspepsia, constipation, nasopharyngitis, weight increased

Pregnancy Third-trimester exposure risks neonatal EPS/withdrawal symptoms; no clearly established increased malformation risk.

Lactation Present in human milk; monitor infant for sedation, failure to thrive, jitteriness, EPS.

Cost

Paliperidone (INVEGA)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
1.5 mg	ER tab	30 qd	$24.61	offered
3 mg	ER tab	30 qd	$29.16	offered
6 mg	ER tab	30 qd	$31.38	offered
9 mg	ER tab	30 qd	$31.67	offered

Generic entry2015

⚠ BOXED WARNING

Increased mortality in elderly patients with dementia-related psychosis

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability2 / 4

Sedation liability2 / 4

QT / Torsades1 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.

Open Paliperidone in the interactive console ↗

Memory aids: interaction avatars

Box: minimal PK interactions

Open Paliperidone in the interactive console ↗