Invega (Paliperidone) Antipsychotic Medication

Uses, Side Effects, Interactions, and Warnings

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Invega is an atypical antipsychotic approved for the treatment of schizophrenia and schizoaffective disorder by the U.S. Food and Drug Administration (FDA). While not yet approved for such treatment, Invega is often prescribed off-label to treat acute bipolar mania.

Invega is derived from the active metabolite of Risperdal (risperidone) called paliperidone. An active metabolite is the active form of a drug after it has been processed by the body. What this means is that Invega may be able to deliver many of the same therapeutic results as Risperdal but with fewer extrapyramidal side effects (e.g., involuntary jerking movements).


Invega comes in three formulations, one oral and two injectable:

  • Invega extended-release tablet is taken once daily, usually in the morning, with or without food. It should be swallowed whole without crushing or chewing. You may see what looks like an undigested pill in your stool after taking the drug. This is only the shell of the pill, which is not absorbed during digestion
  • Invega Sustenna and Invega Trinza are long-acting injectables. Invega Sustenna is an intramuscular injection is given every month. Once you have received at least four doses, you can be switched to Invega Trinza for a maintenance injection every three months.

How Invega Works

Invega works by normalizing the balance of the serotonin and dopamine in the brain. 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 sensations)
  • Disorganized thinking and speech
  • Disorganized and unpredictable behavior

It has also been proposed that Invega may help treat some bipolar mania symptoms as well, including:

  • Hyperactivity and the decreased need for sleep
  • Impulsive or risky behavior
  • Excessive energy or agitation
  • An exaggerated sense of well-being
  • Racing thoughts


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.

Both investigating teams agreed that more and better studies need to be performed.

Common Side Effects

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.

Call your doctor if the side effects are persistent or severe.

Serious Side Effects

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)
  • Confusion
  • Rapid heartbeat (tachycardia)
  • Profuse sweating
  • A feeling of impending doom

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

  • Seizures, tics, tremors, or convulsions
  • Muscle rigidity
  • Falling down
  • Irregular heartbeat (arrhythmia)
  • Loss of consciousness (syncope)
  • Strange body movements you can't control (dystonia)
  • Slowed body movements
  • A painful erection that can last for hours (priapism)

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

In such instances, your doctor may need to adjust your dosage or substitute with another drug. As Invega can make you drowsy, 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 of adults.

Precautions and Considerations

Invega may increase your risk of developing type 2 diabetes. It is important to have your blood sugar monitored regularly while on Invega treatment.

Let your doctor know if you have or have ever had any medical conditions such as the following:

  • Parkinson's disease
  • Seizures
  • Balance problems
  • Low potassium or magnesium
  • Head injury
  • Brain tumor
  • Breast cancer
  • Inflammatory bowel disease

While not contraindicated for use, Invega may exacerbate these conditions. In some cases, your condition can be monitored to avoid complications; in others, Invega may need to be stopped altogether.

If you are pregnant, planning to become pregnant, or are breastfeeding, tell your doctor immediately. While is not yet known whether Invega can harm a fetus or newborn, it is important to discuss the pros and cons of treatment with your doctor to make an informed choice.

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