What should I consider and how do I change or switch a patient from a different long-acting injectable medication (LAI) to Invega Sustenna (paliperidone palmitate)?

When changing or switching from a different LAI to paliperidone palmitate LAI (Invega Sustenna), stop the current LAI and follow the guidance for using Invega Sustenna, including this guidance with regard to establishing tolerability.

Detailed protocols for switching between LAIs have not all been established, but it is recommended by the manufacturer of Invega Sustenna that the initial dose should be given in place of the next scheduled injection of previous LAI (usual loading dose not recommended). Monthly Invega Sustenna injections would then follow, as the usual day 8 second loading dose is not recommended when switching to Invega Sustenna from another LAI (note, this guidance is for Invega Sustenna only, not Invega Trinza). Time to reach a steady state for Invega Sustenna is one week.

When thinking about the dose of the new LAI (here Invega Sustenna), exact equivalent dosages between antipsychotics are not known. Invega Sustenna is available in 39 mg, 78 mg, 117 mg, 156 mg, and 234 mg strengths, and patients’ dosage needs will vary on necessary maintenance doses. Additionally, side effects can vary substantially between antipsychotic medications. A meta-analysis of dosage curves found comparative doses of oral and LAI antipsychotic medications with similar efficacy .

FDA medication label

• Information on this topic is found in the FDA medication label. Here is the most recent label, at the time of writing.
• Medication labels can be found by searching Drugs@FDA at the FDA website. Labels are also available using the Drugs@FDA app for Apple or Android devices. Labels change over time, and the current label should always be consulted.

References

• Janssen Pharmaceutica. (2021). Invega Sustenna: Highlights of Prescribing Information. Retrieved April 10, 2020 from http://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/INVEGA+SUSTENNA-pi.pdf
• Stahl, S. M. (2017). The prescriber’s guide: Stahl’s essential psychopharmacology (6th ed.). New York: Cambridge University Press.

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