Invega: Benefits, Side Effects, Dosage, and Interactions

Medication that can reduce symptoms of schizophrenia

Invega (paliperidone) is a second generation antipsychotic that may be used to reduce the symptoms of certain mental illnesses, such as schizophrenia and schizoaffective disorder.

It can help you think more clearly, feel less agitated, and behave more productively.

For many people, Invega may have fewer side effects than other antipsychotic drugs. It may be taken via a long-acting injection which can help with adherence and may allow you to not have to take a daily pill.

How Invega Works

Invega works by restoring the balance of certain neurotransmitters in the brain. Invega impacts dopamine and serotonin in the brain. It works similarly and is chemically related to Risperdal, but often with fewer extrapyramidal side effects (such as tremor or stiffness).

Serotonin is thought to regulate anxiety and mood, among several other functions. Dopamine is central to such central nervous system functions as movement, pleasure, attention, mood, and motivation.

By balancing these neurotransmitters in the brain, Invega can help alleviate some of the symptoms of schizophrenia, including:

  • Delusions (false beliefs)
  • Hallucinations (false sensory experiences)
  • Disorganized thinking and speech
  • Disorganized and unpredictable behavior

What to Expect

It may take several weeks for Invega to take full effect so it may be a while before you know if it's the right medication for you.

Hallucinations, delusions, and disorganized thinking may improve in the first 1 to 2 weeks. These symptoms may not completely go away.

However, symptoms often become better the longer you take Invega.

It's important to talk to your doctor about how you're feeling, what symptoms you're experiencing, and any improvements you're seeing as you begin Invega. It's also important to be on the lookout for potential side effects.

Invega Dosage

Invega tablets are usually taken once per day or as directed by your doctor. The dose usually ranges from 3 mg to 12 mg. Typically, you'll be prescribed a low dose to start and then the dose may slowly be increased over several weeks.

Tablets should be swallowed whole (they should not be crushed, broken, or chewed).

Patients who tolerate the pill form well may be able to take long-acting injections. This can be especially helpful if you tend to forget your medication, don't want to be on pills, or if adherence is a problem.

Types of Invega

There are different types of Invega that you may be prescribed, with different dosage and timing.

Invega Sustenna

Invega Sustenna is an intramuscular injection given every month. It needs to be given by a healthcare professional.

It's usually injected into the upper arm or buttocks. The first two doses are usually given one week apart. After the first two doses, the medication is usually given once a month (or as directed by your doctor).

The medication is gradually released over time to help control symptoms.

Invega can be discontinued in pill form after two starting doses of Invega Sustenna. Then, patients no longer have to worry about missing doses of their medicine.

Invega Trinza

Invega Trinza is an injection that lasts three months, meaning that patients only need to take four doses per year. Like Invega Sustenna, it is administered by a healthcare professional in the upper arm or buttocks.

It may be administered once patients have been adequately treated with Invega Sustenna a for at least four months.

Invega Trinza means patients don't have to attend as many appointments and they don't have to remember to take their prescription on a daily basis.

Invega Effectiveness

When used to treat schizophrenia, studies have consistently shown that Invega is both effective and well-tolerated, whether in pill form or as an injection. For schizoaffective disorder, Invega has proven equally effective as a maintenance therapy, preventing the reappearance of symptoms.

By contrast, there have been few studies evaluating the effectiveness of Invega in treating acute bipolar mania. Of those that have been performed, results have been largely mixed.

A 2012 review of studies from Nova Southeastern University in Florida concluded that Invega may be safe and useful in treating acute episodes of mania in bipolar disorder at higher doses.

By contrast, a 2018 meta-analysis from China reported that Invega performed no better than a placebo in people with bipolar mania and caused far more side effects.

Common Side Effects of Invega

The most common side effects associated with Invega use include:

  • Restlessness
  • Dizziness (vertigo)
  • Headaches
  • Fatigue
  • Balance problems
  • Muscle weakness
  • Increased saliva production
  • Stomach pain
  • Weight gain
  • Constipation
  • Heartburn
  • Increase in the hormone prolactin

Invega SUSTENNA and Invega TRINZA were associated with the additional side effects of injection site redness, swelling, or pain.

Talk to your doctor if the side effects are persistent or severe, and ask questions before you start treatment so that you're better prepared if side effects do arise.

Schizophrenia Discussion Guide

Get our printable guide to help you ask the right questions at your next doctor's appointment.

Mind Doc Guide

Serious Side Effects of Invega

Some side effects of Invega can be serious. In rare cases, a person may be allergic to Invega and develop a potentially deadly, all-body reaction known as anaphylaxis. Call 911 or go to the nearest emergency room if you develop any of the following:

  • Rash or hives
  • Shortness of breath and/or wheezing
  • Difficulty swallowing (dysphagia)
  • Swelling in the face, throat, neck, or extremities
  • High fever (over 100.4 F)
  • Neuroleptic malignant syndrome (which is rare with this medication)

Serious side effects of Invega Sustenna and Invega Trinza are also uncommon but may include:

  • Seizures, tics, tremors, or convulsions
  • Muscle rigidity
  • Irregular heartbeat (arrhythmia)
  • A painful erection that can last for hours (priapism)

Long-Term Side Effects of Invega

Tardive dyskinesia is a side effect that develops with long-term use of antipsychotics. Symptoms include grimacing, sucking, smacking of lips, and other involuntary movements.

While the risk of tardive dyskinesia is lower in Invega as compared to many other antipsychotics, the risk still exists.

If you're taking any antipsychotic, it's important for your doctor to monitor for any involuntary movements on a regular basis.

Invega Drug Interactions

Tell your doctor about any or all medication you may be taking, whether they be over-the-counter, prescription, nutritional, herbal, or homeopathic. Some may interact with Invega, including:

  • Anti-arrhythmic (irregular heartbeat) drugs
  • Anticonvulsant (anti-seizure) drugs
  • Antidepressants
  • Antihypertensive (high blood pressure) drugs
  • Anxiolytic (anti-anxiety) drugs
  • Certain antibiotics, such as Avelox (moxifloxacin) or Erythrocin (erythromycin)
  • Sedatives and sleeping pills
  • St. John's Wort

Invega may block the effects of drugs used to treat Parkinson's disease, such as bromocriptine, pramipexole, ropinirole, levodopa, and others.

Invega may also lower blood pressure. Medications used to lower blood pressure may increase this effect and increase your risk of falls.

Carbamazepine (Tegretol, Equatro) may decrease the effects of Invega.

Invega can make you drowsy so it's important to be cautious about driving or operating heavy machinery. Alcohol can amplify these effects and should be avoided.


Invega carries the same black box warning as other atypical antipsychotics regarding the increased risk of death in elderly people with dementia-related psychosis. Invega, either in pill or injectable form, is not approved for use in this population.

Invega is also contraindicated for patients with a known sensitivity to risperidone or Risperdal Consta.

Precautions and Considerations

Invega may contribute to weight gain and increase in blood sugars and lipids. It is important to have your blood sugar monitored while undergoing Invega treatment.

Let your doctor know if you have or have ever had any other medical conditions.

If you are pregnant, planning to become pregnant, or are breastfeeding, tell your doctor immediately. Although there are no known risks based on animal studies, human data around potential risks is limited. Therefore, it is important to discuss the pros and cons of treatment with your doctor to make an informed choice.

7 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Alliance on Mental Illness. Paliperidone (Invega).

  2. Bishara D. Once-monthly paliperidone injection for the treatment of schizophrenia. Neuropsychiatr Dis Treat. 2010;6:561-72. doi:10.2147/NDT.S8505

  3. González-Rodríguez A, Catalán R, Penadés R, et al. Profile of paliperidone palmitate once-monthly long-acting injectable in the management of schizophrenia: long-term safety, efficacy, and patient acceptability - a review. Patient Prefer Adherence. 2015;9:695-706. doi:10.2147/PPA.S63948

  4. Lindenmayer JP, Kaur A. Antipsychotic Management of Schizoaffective Disorder: A Review. Drugs. 2016;76(5):589-604. doi:10.1007/s40265-016-0551-x

  5. Marino J, English C, Caballero J, Harrington C. The role of paliperidone extended release for the treatment of bipolar disorder. Neuropsychiatr Dis Treat. 2012;8:181-9. doi:10.2147/NDT.S20675

  6. Chang HY, Tseng PT, Stubbs B, et al. The efficacy and tolerability of paliperidone in mania of bipolar disorder: A preliminary meta-analysis. Exp Clin Psychopharmacol. 2017;25(5):422-433. doi:10.1037/pha0000148

  7. Berman BD. Neuroleptic malignant syndrome: a review for neurohospitalistsThe Neurohospitalist. 2011;1(1):41-47. doi:10.1177/1941875210386491

Additional Reading

By Amy Morin, LCSW, Editor-in-Chief
Amy Morin, LCSW, is the Editor-in-Chief of Verywell Mind. She's also a licensed clinical social worker, psychotherapist, and international bestselling author. Her books, including "13 Things Mentally Strong People Don't Do," have been translated into more than 40 languages. Her TEDx talk,  "The Secret of Becoming Mentally Strong," is one of the most viewed talks of all time.