AdultPediatricGeriatricDosage Forms & Strengths tablet, extended release 1.5mg 3mg 6mg 9mg IM injectable suspension prefilled syringe (once monthly, Invega Sustenna) 39mg 78mg 117mg 156mg 234mg IM injectable suspension prefilled syringe (q3month, Invega Trinza) 273mg 410mg 546mg 819mg IM injectable suspension prefilled syringe (q6month, Invega Hafyera) 1,092mg/3.5mL 1,560mg/5mL Schizophrenia PO 6 mg PO qAM; may be titrated upward or downward in increments of 3 mg/day at intervals ≥5 days; not to exceed 12 mg/day IM, extended-released 1-month (Invega Sustenna) 234 mg in deltoid on treatment day 1, then 156 mg 1 week later (day 8) Recommended maintenance dose is 117 mg IM once monthly, although some patients may require lower or higher dosages (monthly dose range 39-234 mg) IM, extended-released 3-months (Invega Trinza) Patients must be adequately treated with Invega Sustenna (1-month paliperidone) for at least 4 months before initiating Invega Trinza Dose initiation dependent on once-monthly Invega Sustenna dose Initiate Invega Trinza when the next 1-month paliperidone dose is scheduled with an Invega Trinza dose based on the previous 1-month injection dose (see below) Conversion from monthly injection to 3-month injection Invega Sustenna 78 mg/month: Initiate Invega Trinza at 273 mg IM q3mo Invega Sustenna 117 mg/month: Initiate Invega Trinza at 410 mg IM q3mo Invega Sustenna 156 mg/month: Initiate Invega Trinza at 546 mg IM q3mo Invega Sustenna 234 mg/month: Initiate Invega Trinza at 819 mg IM q3mo Conversion from 3-month IM injection to extended-release tablets 273 mg IM (last 3 months to 24wk): 3 mg ER tab 410 mg IM (last 3 months to 24wk): 3 mg ER tab; 6 mg if >24wk 546 mg IM (last 3 months to 18 wk): 3 mg ER tab; 6 mg if 18-24 wk; 9 mg if >24 wk 819 mg IM (last 3 months to 18 wk): 6 mg ER tab; 9 mg if 18-24 wk; 12 mg if >24 wk IM, extended-released 6-months (Invega Hafyera) Patients must be adequately treated with Invega Sustenna (1-month paliperidone) for at least 4 months OR with Invega Trinza (3-month paliperidone) for at least one 3-month cycle before initiating Invega Hafyera Conversion from monthly injection to 6-month injection Initiate Invega Hafyera when next Invega Sustenna dose is scheduled Invega Sustenna 156 mg/month: Initiate Invega Hafyera at 1,092 mg IM q6mo Invega Sustenna 234 mg/month: Initiate Invega Hafyera at 1,560 mg IM q6mo There are no equivalent doses of Invega Hafyera for Invega Sustenna 39-mg, 78-mg, or 117-mg doses, which were not studied Conversion from 3-month injection to 6-month injection Initial Invega Hafyera dose is based on the previous Invega Trinza Initiate Invega Hafyera when next Invega Trinza dose is scheduled May administer Invega Hafyera dose up to 2 weeks before or after the next scheduled Invega Trinza Invega Trinza 546 mg q3mo: Initiate Invega Hafyera at 1,092 mg IM q6mo Invega Trinza 819 mg q3mo: Initiate Invega Hafyera at 1,560 mg IM q6mo There are no equivalent doses of Invega Hafyera for Invega Trinza 273-mg or 410-mg doses, which were not studied Dosing interval and dosage adjustments Following initial dose, administer Invega Hafyera IM q6mo May adjust dosage every 6 months between 1,092 mg and 1,560 mg based on individual response and tolerability, if necessary Owing to the potential longer duration to Invega Hafyera, patient’s response to an adjusted dose may not be apparent for several months Schizoaffective Disorder Indicated for schizoaffective disorder as monotherapy and as an adjunct to mood stabilizers or antidepressants 6 mg PO qDay in am (range 3-12 mg); titration may not be necessary; if exceeding 6 mg/day, increases of 3 mg/day recommended at intervals of 4 days of more; not to exceed 12 mg/day IM (initial): 234 mg in deltoid on treatment day 1, then 156 mg 1 week later (day 8) IM (maintenance): Administer once each month IM in deltoid or gluteal muscle; adjust dose based on tolerability and/or efficacy using available strengths; maintenance dose ranges between 78-234 mg once monthly Dosing Modifications Renal impairment (PO) CrCl 50-79 mL/min: 3 mg/day initially; not to exceed 6 mg/day CrCl 10-49 mL/min: 1.5 mg/day initially; not to exceed 3 mg/day CrCl <10 mL/min: Not recommended Renal impairment (IM) Invega Hafyera: Not recommended for all severities of renal impairment Invega Sustenna Mild (CrCl 50-79 mL/min): 156 mg IM in deltoid on treatment day 1, then 117 mg 1 week later; maintenance: 78 mg IM monthly Moderate to severe (CrCl <50 mL/min): Not recommended Invega Trinza Mild (CrCl 50-79 mL/min): Adjust dosage and stabilize the patient using the 1-month paliperidone palmitate extended-release injectable suspension (Invega Sustenna), then transition to Invega Trinza Moderate to severe (CrCl <50 mL/min): Not recommended Hepatic impairment IM: Not studied PO Mild-to-moderate: No dosage adjustment necessary Severe: Not studied Dosing Considerations Patients with Parkinson disease or dementia with Lewy bodies can experience increased sensitivity to paliperidone Manifestations can include confusion, obtundation, postural instability with frequent falls, extrapyramidal symptoms, and clinical features consistent with neuroleptic malignant syndromeDosage Forms & Strengths tablet, extended-release 1.5mg 3mg 6mg 9mg Schizophrenia <12 years: Safety and efficacy not established ≥12 years (<51 kg): 3 mg/day PO initially; may be increased if necessary in increments of 3 mg/day at intervals ≥5 days; not to exceed 6 mg/day ≥12 years (≥51 kg): 3 mg/day PO initially; may be increased if necessary in increments of 3 mg/day at intervals ≥5 days; not to exceed 12 mg/day Schizoaffective Disorder <18 years: Safety and efficacy not establishedAfter oral administration in elderly subjects, the peak plasma concentration and AUC increased 1.2-fold compared to young subjects; may be attributable to age-related decreases in creatinine clearanceInteraction CheckerEnter a drug name and paliperidoneNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (3)amisulprideamisulpride, paliperidone. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndrome.goserelingoserelin increases toxicity of paliperidone by QTc interval. Contraindicated. Increases risk of torsades de pointes.leuprolideleuprolide increases toxicity of paliperidone by QTc interval. Contraindicated. Increases risk of torsades de pointes.Serious - Use Alternative (102)adagrasibadagrasib, paliperidone. Either decreases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.afatinibpaliperidone increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.alfuzosinalfuzosin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.amiodaroneamiodarone and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.amisulprideamisulpride and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.anagrelideanagrelide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.apomorphinepaliperidone decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.apomorphine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.aripiprazolearipiprazole and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.arsenic trioxidearsenic trioxide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.artemetherartemether and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.asenapineasenapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.asenapine transdermalasenapine transdermal and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.atomoxetineatomoxetine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.benzhydrocodone/acetaminophenbenzhydrocodone/acetaminophen, paliperidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.bromocriptinepaliperidone decreases effects of bromocriptine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.buprenorphinebuprenorphine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine buccalbuprenorphine buccal and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine subdermal implantbuprenorphine subdermal implant and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine transdermalbuprenorphine transdermal and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine, long-acting injectionbuprenorphine, long-acting injection and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.cabergolinepaliperidone decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.calcium/magnesium/potassium/sodium oxybatespaliperidone, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.ceritinibceritinib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.clozapineclozapine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.degarelixdegarelix and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.desfluranedesflurane and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.disopyramidedisopyramide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.donepezildonepezil and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.dopaminepaliperidone decreases effects of dopamine by pharmacodynamic antagonism. Contraindicated.edoxabanpaliperidone will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommendedeliglustateliglustat and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.encorafenibencorafenib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.entrectinibpaliperidone and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.erdafitiniberdafitinib will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.eribulineribulin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.escitalopramescitalopram increases toxicity of paliperidone by QTc interval. Avoid or Use Alternate Drug.fexinidazolefexinidazole and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.fingolimodfingolimod and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.gilteritinibgilteritinib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.glasdegibpaliperidone and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.granisetrongranisetron and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.histrelinhistrelin increases toxicity of paliperidone by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.hydrocodonehydrocodone, paliperidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.hydroxychloroquine sulfatehydroxychloroquine sulfate and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.hydroxyzinehydroxyzine and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.ibutilideibutilide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.indapamideindapamide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.inotuzumabinotuzumab and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.isofluraneisoflurane and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.ivosidenibivosidenib and paliperidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.lasmiditanlasmiditan increases levels of paliperidone by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.lefamulinlefamulin and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.levodopapaliperidone decreases effects of levodopa by pharmacodynamic antagonism. Avoid or Use Alternate Drug.levodopa inhaledpaliperidone decreases effects of levodopa inhaled by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Atypical (2nd generation) antipsychotics inhibit dopamine D2 receptors in varying degrees (clozapine and quetiapine are lower risk). .lisuridepaliperidone decreases effects of lisuride by pharmacodynamic antagonism. Contraindicated.lithiumlithium and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.macimorelinmacimorelin