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| Clinical data | |
|---|---|
| Trade names | Invega, others |
| Other names | 9-hydroxyrisperidone; PP; PP1M; PP3M; PP6M; JNS-010; RO-92670; RO92670 |
| AHFS/Drugs.com | Monograph |
| MedlinePlus | a607005 |
| License data | |
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| Routes of administration | By mouth,intramuscular |
| Drug class | Atypical antipsychotic |
| ATC code | |
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| Legal status | |
| Pharmacokinetic data | |
| Bioavailability | 28% (oral) |
| Eliminationhalf-life | 23 hours (by mouth) |
| Excretion | 1% unchanged in urine 18% unchanged in feces |
| Identifiers | |
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| CAS Number |
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| PubChemCID | |
| DrugBank |
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| KEGG | |
| ChEBI |
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| ChEMBL |
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| ECHA InfoCard | 100.117.604 |
| Chemical and physical data | |
| Formula | C23H27FN4O3 |
| Molar mass | 426.492 g·mol−1 |
| 3D model (JSmol) | |
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Paliperidone, sold under the brand nameInvega among others, is anatypical antipsychotic.[13] It is used for the treatment ofschizophrenia andschizoaffective disorder.[13][14] It is marketed byJanssen Pharmaceuticals.[3]
Paliperidone was approved by the USFood and Drug Administration (FDA) for the treatment of schizophrenia in December 2006,[3] and in the European Union in June 2007.[7] Paliperidone palmitate is a long-acting injectable formulation of paliperidonepalmitoylester.[13][15] It is on theWorld Health Organization's List of Essential Medicines.[16] Paliperidone is available as ageneric medication.[12]
In the United States, paliperidone isindicated for the treatment of schizophrenia and for the treatment of schizoaffective disorder as monotherapy and as an adjunct to mood stabilizers and/or antidepressants.[3]
In the European Union, paliperidone is indicated for the treatment of schizophrenia in adults and in adolescents fifteen years of age and older and for the treatment of schizoaffective disorder in adults.[7]
Paliperidone is used for the treatment ofschizophrenia andschizoaffective disorder.[14]
The most common side effects include headache,insomnia, sleepiness,parkinsonism (effects similar to Parkinson's disease such as shaking, muscle stiffness and slow movement),dystonia (involuntary muscle contractions),tremor (shaking), dizziness,akathisia (restlessness), agitation, anxiety, depression, weight gain, nausea, vomiting, constipation, dyspepsia (heartburn), diarrhea, dry mouth, tiredness, toothache, muscle and bone pain, back pain, asthenia (weakness),tachycardia (increased heart rate), high blood pressure,prolonged QT interval (an alteration of the electrical activity of the heart),upper respiratory tract infection (nose and throat infections) and cough.[7]
A 2023 study found that paliperidone may worsen verbal learning and memory compared toplacebo in the early months of psychosis treatment.[17]
Other symptoms may include restlessness, increased sweating, and trouble sleeping.[18] Less commonly there may be a feeling of the world spinning, numbness, or muscle pains.[18]
Paliperidone is the primary active metabolite of the older antipsychoticrisperidone.[19][unreliable medical source?] While its specific mechanism of action is unknown, it is believed paliperidone and risperidone act via similar, if not identical, pathways.[20] Its efficacy is believed to result from centraldopaminergic andserotonergic antagonism except paliperidone, like its parent compound risperidone, functions as an inverse agonist at 5-HT2A15. Paliperidone also acts as an antagonist of alpha-1 and alpha-2 adrenergic receptors as well as H1 histaminergic receptors.[19] Food is known to increase the absorption of Invega type ER OROS prolonged-release tablets. Food increased exposure of paliperidone by up to 50-60%; however, half-life was not significantly affected. The effect was probably due to a delay in the transit of the ER OROS formulation in the upper part of the GI tract, resulting in increased absorption.[21]
Risperidone and its metabolite paliperidone are reduced in efficacy byP-glycoproteininducers such asSt John's wort[22][23]
| Medication | Brand name | Class | Vehicle | Dosage | Tmax | t1/2 single | t1/2 multiple | logPc | Ref |
|---|---|---|---|---|---|---|---|---|---|
| Aripiprazole lauroxil | Aristada | Atypical | Watera | 441–1064 mg/4–8 weeks | 24–35 days | ? | 54–57 days | 7.9–10.0 | |
| Aripiprazole monohydrate | Abilify Maintena | Atypical | Watera | 300–400 mg/4 weeks | 7 days | ? | 30–47 days | 4.9–5.2 | |
| Bromperidol decanoate | Impromen Decanoas | Typical | Sesame oil | 40–300 mg/4 weeks | 3–9 days | ? | 21–25 days | 7.9 | [24] |
| Clopentixol decanoate | Sordinol Depot | Typical | Viscoleob | 50–600 mg/1–4 weeks | 4–7 days | ? | 19 days | 9.0 | [25] |
| Flupentixol decanoate | Depixol | Typical | Viscoleob | 10–200 mg/2–4 weeks | 4–10 days | 8 days | 17 days | 7.2–9.2 | [25][26] |
| Fluphenazine decanoate | Prolixin Decanoate | Typical | Sesame oil | 12.5–100 mg/2–5 weeks | 1–2 days | 1–10 days | 14–100 days | 7.2–9.0 | [27][28][29] |
| Fluphenazine enanthate | Prolixin Enanthate | Typical | Sesame oil | 12.5–100 mg/1–4 weeks | 2–3 days | 4 days | ? | 6.4–7.4 | [28] |
| Fluspirilene | Imap, Redeptin | Typical | Watera | 2–12 mg/1 week | 1–8 days | 7 days | ? | 5.2–5.8 | [30] |
| Haloperidol decanoate | Haldol Decanoate | Typical | Sesame oil | 20–400 mg/2–4 weeks | 3–9 days | 18–21 days | 7.2–7.9 | [31][32] | |
| Olanzapine pamoate | Zyprexa Relprevv | Atypical | Watera | 150–405 mg/2–4 weeks | 7 days | ? | 30 days | – | |
| Oxyprothepin decanoate | Meclopin | Typical | ? | ? | ? | ? | ? | 8.5–8.7 | |
| Paliperidone palmitate | Invega Sustenna | Atypical | Watera | 39–819 mg/4–12 weeks | 13–33 days | 25–139 days | ? | 8.1–10.1 | |
| Perphenazine decanoate | Trilafon Dekanoat | Typical | Sesame oil | 50–200 mg/2–4 weeks | ? | ? | 27 days | 8.9 | |
| Perphenazine enanthate | Trilafon Enanthate | Typical | Sesame oil | 25–200 mg/2 weeks | 2–3 days | ? | 4–7 days | 6.4–7.2 | [33] |
| Pipotiazine palmitate | Piportil Longum | Typical | Viscoleob | 25–400 mg/4 weeks | 9–10 days | ? | 14–21 days | 8.5–11.6 | [26] |
| Pipotiazine undecylenate | Piportil Medium | Typical | Sesame oil | 100–200 mg/2 weeks | ? | ? | ? | 8.4 | |
| Risperidone | Risperdal Consta | Atypical | Microspheres | 12.5–75 mg/2 weeks | 21 days | ? | 3–6 days | – | |
| Zuclopentixol acetate | Clopixol Acuphase | Typical | Viscoleob | 50–200 mg/1–3 days | 1–2 days | 1–2 days | 4.7–4.9 | ||
| Zuclopentixol decanoate | Clopixol Depot | Typical | Viscoleob | 50–800 mg/2–4 weeks | 4–9 days | ? | 11–21 days | 7.5–9.0 | |
| Note: All byintramuscular injection.Footnotes:a =Microcrystalline ornanocrystallineaqueous suspension.b = Low-viscosityvegetable oil (specificallyfractionated coconut oil withmedium-chain triglycerides).c = Predicted, fromPubChem andDrugBank.Sources:Main: See template. | |||||||||
| Site | Ki (nM) |
|---|---|
| 5-HT1A | 6.17 |
| 5-HT2A | 1 |
| 5-HT2C | 48 |
| 5-HT6 | 24 |
| 5-HT7 | 2.7 |
| α1A | 2.5 |
| α2A | 3.9 |
| α2C | 2.7 |
| D1 | 41 |
| D2 | 1.6 |
| D3 | 3.5 |
| D4 | 54[34] |
| D5 | 29 |
| H1 | 19 |
| H2 | 121 |
| mACh | >10,000 |
Values are Ki (nM). The smaller the value, the more strongly the drug binds to the site.
Paliperidone (as Invega) was approved by the USFood and Drug Administration (FDA) for the treatment ofschizophrenia in 2006. Paliperidone was approved by the FDA for the treatment of schizoaffective disorder in 2009. The long-acting injectable form of paliperidone, marketed as Invega Sustenna in the US,[5] and Xeplion in the EU,[11] was approved by the FDA in July 2009.
It was initially approved in the European Union in 2007, for schizophrenia, the extended release form and use for schizoaffective disorder were approved in the EU in 2010, and extension to use in adolescents older than 15 years old was approved in 2014.[35]
In April 2014, it was reported that 21 Japanese people who had received shots of the long-acting injectablepaliperidone palmitate had died, out of 10,700 individuals prescribed the drug.[36][37][38][39][40][41][42][excessive citations]
On December 4, 2014, a 5-year-old Spanish boy, Borja Piriz Matía, died 15 days after he started taking paliperidone (Invega) 3 mg.[43]
In 2019, it was reported that a 33-year-old man died after a single injection of 819 mg of Trevicta (paliperidone palmitate three-monthly injection), with paliperidone poisoning appearing to be the highly likely cause of death.[44]
On January 17, 2020, a video titled "Medical Help" was uploaded to YouTube by 26-year-old Wail Ardab ofPalatka, Florida, who developeddystonia andinsomnia after taking Invega Trinza injections.[45] On March 5, 2020, Ardab committed suicide by jumping fromMemorial Bridge in Palatka.[46]
From June 2023 to April 2024, Serbiantelevision presenter and journalist Bojana Nikolić Janković posted to the internet forumBluelight that she received 4 shots of Invega Sustenna and 2 shots of Invega Trinza due to the stress of her divorce from Ognjen Janković, a member of the hip-hop groupBeogradski Sindikat. Janković, known for hosting the showCity, wrote that she wasbedridden withanhedonia,cognitive issues, low energy and other symptoms after receiving the injections.[47][48] She died inBelgrade on April 19, 2024, at age 46.[49]
On December 28, 2021, 19-year-old Peyton Moyer fatally shot his mother and her boyfriend inWatkinsville, Georgia, while under the influence of the long-acting injectable paliperidone palmitate (Invega Sustenna).[50] On November 2, 2023, Moyer was sentenced tolife in prison.[51]
In April 2025, Wisner Baum filed a lawsuit alleging that Johnson & Johnson andEli Lilly concealed that Invega, Risperdal,Zyprexa, and their generics are linked tobreast cancer. The case isBrown v. Johnson & Johnson et al (Case No. 25CV119808).[52]
In May 2015, a formulation of paliperidone palmitate was approved by the USFood and Drug Administration under the brand name Invega Trinza.[53][6] A similar prolonged release suspension was approved in 2016 by theEuropean Medicines Agency originally under the brand name Paliperidone Janssen, later renamed to Trevicta.[54] In September 2021, a newer formulation of paliperidone palmitate, Invega Hafyera, was approved by the US FDA.[4]
