Invega Trinza Dosage/Direction for Use

Paliperidone palmitate (Invega Trinza) is to be used only after the 1-month paliperidone palmitate injectable product has been established as adequate treatment for at least four months. In order to establish a consistent maintenance dose, it is recommended that the last two doses of the 1-month injection be the same dosage strength before starting Paliperidone palmitate (Invega Trinza).
Dosage: Initiate Paliperidone palmitate (Invega Trinza) at the time when the next 1-month paliperidone palmitate dose was to be scheduled with an Paliperidone palmitate (Invega Trinza) dose based on the previous 1-month injection dose as shown in Table 1. Paliperidone palmitate (Invega Trinza) may be administered up to 7 days before or after the monthly time point of the next scheduled paliperidone palmitate 1-month dose. (See Table 1.)

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Following the initial Paliperidone palmitate (Invega Trinza) dose, Paliperidone palmitate (Invega Trinza) should be administered every 3 months. If needed, dose adjustment can be made every 3 months in increments within the range of 175 mg to 525 mg based on individual patient tolerability and/or efficacy. Due to the long-acting nature of Paliperidone palmitate (Invega Trinza), the patient's response to an adjusted dose may not be apparent for several months (see Pharmacology: Pharmacokinetics under Actions).
Missed dose(s): Dosing window: Missing doses of Paliperidone palmitate (Invega Trinza) should be avoided. However, on exceptional occasions, patients may be given the injection up to 2 weeks before or after the 3-month time point.
Missed dose > 3½ months up to 4 months: If more than 3½ months (up to 4 months) have elapsed since the last injection of Paliperidone palmitate (Invega Trinza), the previously administered Paliperidone palmitate (Invega Trinza) dose should be administered as soon as possible, then continue with the 3-month injections following this dose.
Missed dose > 4 months up to 9 months: If more than 4 months (up to 9 months) have elapsed since the last injection of Paliperidone palmitate (Invega Trinza), do NOT administer the next dose of Paliperidone palmitate (Invega Trinza). Instead, use the re-initiation regimen shown in Table 2. (See Table 2.)

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Missed dose > 9 months: If more than 9 months have elapsed since the last injection of Paliperidone palmitate (Invega Trinza), re-initiate treatment with the 1-month paliperidone palmitate injectable product as described in the prescribing information for that product. Paliperidone palmitate (Invega Trinza) can then be resumed after the patient has been adequately treated with the 1-month paliperidone palmitate injectable product for at least 4 months.
Administration information: Parenteral drug products should be inspected visually for foreign matter and discoloration prior to administration. Within 5 minutes prior to administration of Paliperidone palmitate (Invega Trinza) to the patient, it is important to shake the syringe vigorously for at least 15 seconds to ensure a homogeneous suspension (see Instructions for Use and Handling and Disposal under Cautions for Usages).
Paliperidone palmitate (Invega Trinza) is intended for intramuscular use only. Do not administer intravascularly or subcutaneously. Avoid inadvertent injection into a blood vessel. Each injection must be administered only by a health care professional. Administer the dose in a single injection; do not administer the dose in divided injections. Inject slowly, deep into the deltoid or gluteal muscle.
Paliperidone palmitate (Invega Trinza) must be administered using only the thin wall needles that are provided in the Paliperidone palmitate (Invega Trinza) pack. Needles from the 1-month paliperidone palmitate injectable product pack or other commercially-available needles are not to be used when administering Paliperidone palmitate (Invega Trinza).
The recommended needle size for administration of Paliperidone palmitate (Invega Trinza) into the deltoid muscle is determined by the patient's weight. For those ≥ 90 kg (≥ 200 lbs), the 1½-inch, 22 gauge thin wall needle is recommended. For those < 90 kg (< 200 lbs), the 1-inch, 22 gauge thin wall needle is recommended. Administer into the center of the deltoid muscle. Deltoid injections should be alternated between the two deltoid muscles.
The recommended needle size for administration of Paliperidone palmitate (Invega Trinza) into the gluteal muscle regardless of body weight is the 1½-inch, 22 gauge thin wall needle. Administer into the upper-outer quadrant of the gluteal muscle. Gluteal injections should be alternated between the two gluteal muscles.
Since paliperidone is the active metabolite of risperidone, caution should be exercised when Paliperidone palmitate (Invega Trinza) is co-administered with risperidone or with oral paliperidone for extended periods of time. Safety data involving concomitant use of Paliperidone palmitate (Invega Trinza) with other antipsychotics is limited.
Incomplete administration: To avoid an incomplete administration of Paliperidone palmitate (Invega Trinza), ensure that the prefilled syringe is shaken vigorously for at least 15 seconds within 5 minutes prior to administration to ensure a homogeneous suspension (see Instructions for Use and Handling and Disposal under Cautions for Usage). However, in the event of an incompletely administered dose, do not re-inject the dose remaining in the syringe and do not administer another dose. Closely monitor and treat the patient appropriately until the next scheduled 3-month injection of Paliperidone palmitate (Invega Trinza).
Special populations: Pediatrics (less than 18 years of age): Safety and effectiveness of Paliperidone palmitate (Invega Trinza) in patients < 18 years of age have not been studied.
Elderly (65 years of age and older): In general, recommended dosing of Paliperidone palmitate (Invega Trinza) for elderly patients with normal renal function is the same as for younger adult patients with normal renal function. As elderly patients may have reduced renal function, see Renal impairment as follows for dosing recommendations in patients with renal impairment.
Renal impairment: Paliperidone palmitate (Invega Trinza) has not been systematically studied in patients with renal impairment (see Pharmacology: Pharmacokinetics under Actions). For patients with mild renal impairment (creatinine clearance ≥ 50 to < 80 mL/min), dose adjustment is done when initiating treatment with the 1-month paliperidone palmitate injectable product; no dose adjustment of Paliperidone palmitate (Invega Trinza) is required. Transition to Paliperidone palmitate (Invega Trinza) is with a dose in a 3.5 to 1 ratio to the previous stabilized 1-month paliperidone palmitate injectable product as described in Dosage as previously mentioned. The maximum recommended dose of Paliperidone palmitate (Invega Trinza) in patients with mild renal impairment is 350 mg.
Paliperidone palmitate (Invega Trinza) is not recommended in patients with moderate or severe renal impairment (creatinine clearance < 50 mL/min).
Hepatic impairment: Paliperidone palmitate (Invega Trinza) has not been studied in patients with hepatic impairment. Based on a study with oral paliperidone, no dose adjustment is required in patients with mild or moderate hepatic impairment. Paliperidone has not been studied in patients with severe hepatic impairment. (See Pharmacology: Pharmacokinetics under Actions.)
Other populations: No dose adjustment for Paliperidone palmitate (Invega Trinza) is recommended based on gender, race, or smoking status. (For pregnant women and nursing mothers, see Use in Pregnancy & Lactation.)
Switching from other antipsychotic agents: Paliperidone palmitate (Invega Trinza) is to be used only after the patient has been adequately treated with the 1-month paliperidone palmitate injectable product for at least 4 months (see Indications and Dosage & Administration).
If Paliperidone palmitate (Invega Trinza) is discontinued, its prolonged-release characteristics must be considered. As recommended with other antipsychotic medications, the need for continuing existing extrapyramidal symptoms (EPS) medication should be re-evaluated periodically.
Switching from Paliperidone palmitate (Invega Trinza) to the 1-Month Paliperidone Palmitate Injectable Product: For switching from Paliperidone palmitate (Invega Trinza) to the 1-month paliperidone palmitate injectable product, the 1-month paliperidone palmitate injectable product should be administered at the time the next Paliperidone palmitate (Invega Trinza) dose was to be administered using the equivalent 3.5-fold lower dose as shown in Table 3. The 1-month paliperidone palmitate injectable product should then continue dosed at monthly intervals. (See Table 3.)

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Switching from Paliperidone palmitate (Invega Trinza) to Oral Paliperidone Extended-Release Tablets: For switching from Paliperidone palmitate (Invega Trinza) to oral paliperidone extended-release tablets, the daily dosing of the paliperidone extended-release tablets should be started 3 months after the last Paliperidone palmitate (Invega Trinza) dose and transitioned over the next several months following the last Paliperidone palmitate (Invega Trinza) dose as described in Table 4. Table 4 provides dose conversion regimens to allow patients previously stabilized on different doses of Paliperidone palmitate (Invega Trinza) to attain similar paliperidone exposure with once daily paliperidone extended-release tablets. (See Table 4.)

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