Paliperidone LAI

Invega Depot·Psychiatry - Depot Antipsychotics

Maintenance treatment of Schizophrenia, Schizoaffective disorder

Authority requiredPBSDEPOT Q1M/Q3M/Q6MInvega Sustenna (1-month), Invega Trinza (3-month), Invega Hafyera (6-month)Pre-filled syringes+2

Max Dose

150 mg Eq Q4W

Half-life

25–156 Days

Prolactin

HIGH RISK

REQUIRED

Rapid Summary

Overview

The active metabolite of Risperidone formulated as a nanocrystal depot. Extremely convenient as it requires ZERO oral overlap if the specific Day 1 / Day 8 loading protocol is followed.

Maximum Dose

Max 150 mg Eq monthly (Sustenna).

Clinical Focus

Causes massive and sustained hyperprolactinemia. The loading doses MUST be given in the Deltoid muscle to ensure rapid absorption into the blood.

Bottom Line

Paliperidone LAI is a long-acting injectable antipsychotic for schizophrenia maintenance with monthly or 3-monthly dosing, but causes significant hyperprolactinaemia and weight gain.

Formulation & Access

Brand Names

Invega Sustenna (1-month), Invega Trinza (3-month), Invega Hafyera (6-month)

Parenteral

Pre-filled syringes. Does NOT require refrigeration.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Maintenance treatment of Schizophrenia, Schizoaffective disorder.

Clinical Place

The most widely prescribed LAI in Australia due to the lack of oral overlap, making it ideal for non-compliant patients discharging from closed wards.

Quick reference

Class & Role

Invega Depot — The active metabolite of Risperidone formulated as a nanocrystal depot.

Route / Formulation

Pre-filled syringes. Does NOT require refrigeration. (Invega Sustenna (1-month), Invega Trinza (3-month), Invega Hafyera (6-month))

Usual Dose & Max

Day 1: IM 150 mg Eq into the DELTOID. Day 8: IM 100 mg Eq into the DELTOID. No oral overlap needed. Max 150 mg Eq monthly (Sustenna).

Key Indication Doses

Invega Sustenna (1-Monthly) Loading: Day 1: IM 150 mg Eq into the DELTOID. Day 8: IM 100 mg Eq into the DELTOID. No oral overlap needed. Invega Sustenna (Maintenance): IM 50-150 mg Eq every 4 weeks (Deltoid or Gluteal). Invega Trinza (3-Monthly): IM every 12 weeks. ONLY for patients stabilized on Sustenna for at least 4 months.

Best Uses

Paliperidone LAI is a long-acting injectable antipsychotic for schizophrenia maintenance with monthly or 3-monthly dosing, but causes significant hyperprolactinaemia and weight gain.

Avoid / Cautions

Known hypersensitivity to Paliperidone or Risperidone.

Key Risks

Endocrine: Severe hyperprolactinemia (galactorrhea, amenorrhea, gynecomastia, long-term osteoporosis risk). Neurological: Extrapyramidal side effects (EPS), particularly at doses > 100 mg Eq. Metabolic: Weight gain, hyperglycemia.

Key Interactions

Minimal CYP450 metabolism. Cleared largely unchanged by the kidneys, avoiding major hepatic drug interactions. Additive hypotension with antihypertensives (Alpha-1 blockade).

Monitoring

Check eGFR before initiation. Monitor serum Prolactin if sexual dysfunction or lactation occurs. Routine HbA1c and Lipids. Check for EPS (tremor/rigidity).

Clinical Pearl

The loading doses on Day 1 and Day 8 MUST go into the Deltoid muscle. Blood flow is much higher in the arm than the glute. If injected into the glute, the drug absorbs too slowly, and the patient will relapse into psychosis during week 2.

Access

Authority requiredInvega Sustenna (1-month), Invega Trinza (3-month), Invega Hafyera (6-month)

Brand: Invega Sustenna (1-month), Invega Trinza (3-month), Invega Hafyera (6-month)
PBS status: Authority required

Paliperidone LAI

Invega Depot·Psychiatry - Depot Antipsychotics

Maintenance treatment of Schizophrenia, Schizoaffective disorder

Authority requiredPBSDEPOT Q1M/Q3M/Q6MInvega Sustenna (1-month), Invega Trinza (3-month), Invega Hafyera (6-month)Pre-filled syringes+2

Max Dose

150 mg Eq Q4W

Half-life

25–156 Days

Prolactin

HIGH RISK

REQUIRED

Rapid Summary

Overview

The active metabolite of Risperidone formulated as a nanocrystal depot. Extremely convenient as it requires ZERO oral overlap if the specific Day 1 / Day 8 loading protocol is followed.

Maximum Dose

Max 150 mg Eq monthly (Sustenna).

Clinical Focus

Causes massive and sustained hyperprolactinemia. The loading doses MUST be given in the Deltoid muscle to ensure rapid absorption into the blood.

Bottom Line

Paliperidone LAI is a long-acting injectable antipsychotic for schizophrenia maintenance with monthly or 3-monthly dosing, but causes significant hyperprolactinaemia and weight gain.

Formulation & Access

Brand Names

Invega Sustenna (1-month), Invega Trinza (3-month), Invega Hafyera (6-month)

Parenteral

Pre-filled syringes. Does NOT require refrigeration.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Maintenance treatment of Schizophrenia, Schizoaffective disorder.

Clinical Place

The most widely prescribed LAI in Australia due to the lack of oral overlap, making it ideal for non-compliant patients discharging from closed wards.

Quick reference

Class & Role

Invega Depot — The active metabolite of Risperidone formulated as a nanocrystal depot.

Route / Formulation

Pre-filled syringes. Does NOT require refrigeration. (Invega Sustenna (1-month), Invega Trinza (3-month), Invega Hafyera (6-month))

Usual Dose & Max

Day 1: IM 150 mg Eq into the DELTOID. Day 8: IM 100 mg Eq into the DELTOID. No oral overlap needed. Max 150 mg Eq monthly (Sustenna).

Key Indication Doses

Best Uses

Paliperidone LAI is a long-acting injectable antipsychotic for schizophrenia maintenance with monthly or 3-monthly dosing, but causes significant hyperprolactinaemia and weight gain.

Avoid / Cautions

Known hypersensitivity to Paliperidone or Risperidone.

Key Risks

Key Interactions

Minimal CYP450 metabolism. Cleared largely unchanged by the kidneys, avoiding major hepatic drug interactions. Additive hypotension with antihypertensives (Alpha-1 blockade).

Monitoring

Check eGFR before initiation. Monitor serum Prolactin if sexual dysfunction or lactation occurs. Routine HbA1c and Lipids. Check for EPS (tremor/rigidity).

Clinical Pearl

Access

Authority requiredInvega Sustenna (1-month), Invega Trinza (3-month), Invega Hafyera (6-month)

Brand: Invega Sustenna (1-month), Invega Trinza (3-month), Invega Hafyera (6-month)
PBS status: Authority required