Paliperidone Palmitate 3-Month (Invega Trinza)

FDA Approved 2015

Reviewed by the HeyPsych Medical Review Board

Board-certified psychiatrists and mental health professionals

Indications

Primary Indications

Maintenance treatment of schizophrenia in adults stabilized on Invega Sustenna for at least 4 monthsMaintenance treatment of schizoaffective disorder in adults stabilized on Invega Sustenna

Mechanism

Paliperidone palmitate is hydrolyzed to paliperidone, which exerts therapeutic effects primarily via antagonism of dopamine D2 and serotonin 5-HT2A receptors, reducing positive and negative symptoms of psychosis and helping maintain remission.

Dosing

Adult Dosing

Schizophrenia/Schizoaffective disorder: Administer every 3 months (13 weeks) at a dose 3.5 times the previous monthly Invega Sustenna dose.

Dosage Forms

Pre-filled syringes for intramuscular injection: 273 mg, 410 mg, 546 mg, 819 mg

Onset Duration

Steady-state concentrations are achieved after several injection cycles; provides sustained therapeutic plasma levels for 3 months.

Adverse Effects

Common Side Effects

• injection site reactions

• weight gain

• akathisia

• somnolence

• nasopharyngitis

⚠️ Serious Side Effects

neuroleptic malignant syndrome
tardive dyskinesia
severe allergic reaction

Warnings

Critical Safety Information

Increased mortality in elderly patients with dementia-related psychosis; not approved for this use.

→Risk of metabolic changes including hyperglycemia and dyslipidemia
→May cause significant prolactin elevation
→Injection site reactions possible

Interactions

With: CYP3A4 and P-gp inducers

Risk: Reduced plasma levels

Action: Avoid or adjust dose

With: QT-prolonging agents

Risk: Increased risk of arrhythmia

Action: Monitor ECG

Monitoring

Metabolic profile (glucose, lipids)
Weight/BMI
Prolactin levels
Movement disorders
Injection site reactions

Special Populations

👶Pregnancy

Use only if benefits outweigh potential risks.

🤱Breastfeeding

Excreted in breast milk; monitor infant.

👧Children & Adolescents (Under 18)

Not approved for patients under 18 years.

Tapering

Due to prolonged half-life, effects may persist for months after discontinuation; abrupt discontinuation may still lead to symptom recurrence.

Clinical Notes

Requires prior stabilization on Invega Sustenna for at least 4 months.
Extended dosing interval improves adherence in chronic illness.
Injection should be administered in the deltoid or gluteal muscle by a healthcare professional.

This medication information is for educational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider before starting, stopping, or changing any medication. Never take medication without a prescription from a licensed healthcare provider.

Interested in this treatment?

This information is for educational purposes. Always consult with a qualified healthcare provider before starting any new treatment.

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