Paliperidone palmitate LAI
INVEGA TRINZA
3 heads → q 3 month IM injection
What it isEvery-three-month long-acting injectable paliperidone palmitate, a D2 and 5-HT2A antagonist, for schizophrenia.
Why this oneFour injections a year, for patients already stable on at least four months of the monthly product.
What limits itThe very long tail cuts both ways: missed-dose forgiveness is generous, but adverse effects and discontinuation decisions play out over months, not weeks.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Schizophrenia (after ≥4 months on INVEGA SUSTENNA) | adults | Convert from last 1-month dose: 78→273 mg, 117→410 mg, 156→546 mg, 234→819 mg | 273–819 mg every 3 months | 819 mg every 3 months |
Renal Mild (CrCl 50–<80): dose per prior INVEGA SUSTENNA stabilization. Moderate–severe (CrCl <50): not recommended.
Hepatic No adjustment for mild–moderate; not studied in severe.
Administered once every 3 months.
Instructions
- IM only (deltoid or gluteal); administer by a healthcare professional.
- Use only after adequate treatment with 1-month paliperidone palmitate (INVEGA SUSTENNA) for ≥4 months.
- Shake vigorously ≥15 seconds and inject within 5 minutes; use only the thin-wall needles provided.
Available strengths
- inj 273, 410, 546, 819 mg
Cautions
- Cerebrovascular reactions/stroke in elderly with dementia-related psychosis
- Neuroleptic malignant syndrome
- QT prolongation
- Tardive dyskinesia
- Metabolic changes (hyperglycemia/diabetes, dyslipidemia, weight gain)
- Orthostatic hypotension and syncope
- Leukopenia, neutropenia, agranulocytosis
- Hyperprolactinemia
- Seizures
Adverse reactions
- Injection site reaction
- Weight increased
- Headache
- Upper respiratory tract infection
- Akathisia
- Parkinsonism
Pregnancy No established drug-associated risk of major birth defects; third-trimester exposure risks extrapyramidal and/or withdrawal symptoms in neonates.
Lactation Paliperidone present in breast milk; monitor infant for sedation, failure to thrive, jitteriness, and extrapyramidal symptoms.
Cost
| Strength | #/mo | generic $/unit | brand $/unit | CostPlus | |
|---|---|---|---|---|---|
| 273 mg | inj | per unit | — | $3950.95/mL | not offered |
| 410 mg | inj | per unit | — | $3959.46/mL | not offered |
| 546 mg | inj | per unit | — | $3993.63/mL | not offered |
| 819 mg | inj | per unit | — | $3997.97/mL | not offered |
Other forms: Paliperidone palmitate LAI (INVEGA SUSTENNA) · Paliperidone palmitate LAI (ERZOFRI) · Paliperidone palmitate LAI (INVEGA HAFYERA)
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.
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