paliperidone palmitate (Invega Trinza)

Invega trinza (paliperidone palmitate) is an atypical antipsychotic used to treat schizophrenia. It is a longer acting form of Invega sustenna and Invega. Other atypical antipsychotic drugs include olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), asenapine (Saphris), iloperidone (Fanapt) and aripiprazole (Abilify).

Atypical antipsychotics differ from typical antipsychotics because they cause a lesser degree of movement (extrapyramidal) side effects and constipation.

The exact mechanism of action of paliperidone is not known, but, like other anti-psychotics, it is believed that paliperidone affects the way the brain works by interfering with communication among the brain's nerves. Nerves communicate with each other by making and releasing chemicals called neurotransmitters. The neurotransmitters travel to other nearby nerves where they attach to receptors on the nerves. The attachment of the neurotransmitters either stimulates or inhibits the function of the nearby nerves. Paliperidone blocks several of the receptors on nerves including dopamine type 2, serotonin type 2, and alpha 2 adrenergic receptors. It is believed that many psychotic illnesses are caused by abnormal communication among nerves in the brain and that by altering communication through neurotransmitters, paliperidone can alter the psychotic state. Invega trinza was approved by the FDA in May 2015.

What brand names are available for paliperidone palmitate?

Invega Trinza

Is paliperidone palmitate available as a generic drug?

No

Do I need a prescription for paliperidone palmitate?

Yes

The most common side effects include

• injection site reaction,
• weight gain,
• headache,
• upper respiratory tract infection,
• feeling restlessness or difficulty sitting still,
• stiffness and shuffling walk,
• tremors, and
• slow movements.

Less common but serious side effects are increased risk of stroke in elderly patients with dementia-related psychosis.

Neuroleptic malignant syndrome or NMS is a rare but serious side effect associated with the use of antipsychotics. Neuroleptic malignant syndrome may result in death and must be treated in the hospital. Signs and symptoms of heuroleptic malignant syndrome may include

• high fever,
• sweating (diaphoresis),
• severe muscle stiffness or rigidity,
• confusion,
• loss of consciousness,
• high blood pressure,
• rapid heartbeat, and
• changes in breathing breathing.

Extrapyramidal side effects include:

• Dystonia are painful spasms of the oral, throat, or neck muscles that may cause problems with speech, swallowing, and stiff neck.
• Akathisia are feelings of restlessness or difficulty sitting still.
• Pseudoparkinsonism is drug induced Parkinson's symptoms.
• Tardive dyskinesia usually occurs after long term use of antipsychotics and usually presents with movement problems affecting the tongue, lips, jaw, face, and extremities.
• Metabolic changes including high blood sugar (hyperglycemia), diabetes mellitus, increase in blood cholesterol, and weight gain.
• High blood levels of prolactin. Prolactin is a hormone that allows the production of breast milk. High levels of prolactin may cause menstrual abnormalities, leakage of milk from the breast, development of breasts in males (gynecomastia), and erection problems in men.
• Seizures

• Invega trinza is administered once every 3 months by a health-care professional.
• Invega trinza is injected intramuscularly (into the muscle) in the upper arm or upper buttocks.
• The initial starting dose of Invega trinza is based on the last dose of Invega sustenna used.
  • If the last dose of Invega Sustenna is 78 mg; start Invega Trinza at 273 mg
  • If the last dose of Invega Sustenna is 117 mg; start 410 Invega Trinza at mg
  • If the last dose of Invega Sustenna is 156 mg; start 546 Invega Trinza at mg
  • If the last dose of Invega Sustenna is 234 mg; start 819 Invega Trinza at mg

Invega trinza can cause low blood pressure especially when standing up from a sitting down or laying down position (orthostatic hypotension). Therefore, Invega trinza should be used cautiously with other drugs also associated with causing orthostatic hypotension.

Paliperidone is metabolized or broken down by liver enzymes. Drugs that induce these enzymes will increase their activity and consequently decrease blood levels of paliperidone. Paliperidone should not be taken with carbamazepine (Tegretol), phenytoin (Dilantin), rifampin (Rifadin), St. John's Wort, and other drugs that may decrease its blood levels.

Paliperidone blocks the effect of dopamine in the brain while dopamine agonists such as levodopa (Sinemet) increase the levels of dopamine in the brain. Combining these agents is not recommended since the effect of both drugs will be reduced.

Fetuses exposed to antipsychotics during the third trimester of pregnancy are at risk for extrapyramidal and withdrawal symptoms after birth. Symptoms reported included agitation, hypertonia, hypotonia, tremor, somnolence, depressed breathing, and feeding disorder. Currently there is no data on the use of Invega trinza during pregnancy. Invega trinza should only be used during pregnancy if the potential benefit to the mother outweighs the potential for side effects in the fetus.

A pregnancy exposure registry has been established to monitor the use of atypical antipsychotics, including Invega trinza, during pregnancy. All pregnant women treated with atypical antipsychotics are advised to enroll in this pregnancy registry and report any side effects.

Invega trinza is known to enter human milk but its effects on the breastfeeding infant or milk production is not yet known.

What preparations of paliperidone palmitate are available?

Extended-release injectable suspension: 273, 410, 546, or 819 mg

How should I keep paliperidone palmitate stored?

Invega trinza should be stored at room temperature between 15 C to 30 C (59 F and 86 F).