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Overview: Invega Sustenna is used to treat schizophrenia and schizoaffective disorder. It is a long-acting injection given once a month into a muscle by a health care provider. Common side effects include drowsiness; dizziness; and pain, itching, swelling, or redness near where the needle went in. Invega Sustenna can affect your alertness or coordination. It can also affect your body’s ability to regulate temperature. Try to avoid getting overheated, stay hydrated, and wear light and breathable clothing while you are using Invega Sustenna.

Uses

What is Invega Sustenna used for?

Invega Sustenna (paliperidone) is commonly used to treat schizophrenia and schizoaffective disorder.

Learn more about Invega for Schizophrenia Treatment.

Invega Sustenna may also be used for other conditions as determined by your health care provider.

See also: Erzofri, Invega Hafyera, Invega Trinza, and Paliperidone

How does Invega Sustenna work (mechanism of action)?

Invega Sustenna belongs to a group of medicines called second-generation (atypical) antipsychotics. It is thought to work by balancing brain chemicals called serotonin and dopamine. These chemicals are known to affect thoughts and mood.

How is Invega Sustenna supplied (dosage forms)?

Brands and other names

  • Invega Sustenna

Dosage forms and strengths

Invega Sustenna is available in an injectable form that is given by a health care provider.

How should I store Invega Sustenna?

Invega Sustenna is usually given by a health care provider in a hospital, clinic, or pharmacy. You will not store it at home.

Side Effects

What are the most common side effects of Invega Sustenna?

The most common side effects of Invega Sustenna are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Pain, itching, swelling, or redness near where the needle went in
  • Drowsiness
  • Dizziness
  • Restlessness (akathisia)
  • Movement problems

There may be other side effects of Invega Sustenna that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of Invega Sustenna?

While less common, the most serious side effects of Invega Sustenna are described below, along with what to do if they happen.

Severe Allergic Reactions. Invega Sustenna may cause allergic reactions, which can be serious. Stop using Invega Sustenna and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Heart Rhythm Changes. Invega Sustenna may cause a rare, dangerous heart rhythm problem called QT prolongation and torsade de pointes. Some people have a higher risk of this, including people who are older, have other people in their family who have had these conditions, have low potassium or magnesium levels, or who take medicines that can prolong the QT interval. Tell your health care provider right away if you faint or have changes in your heart rate or rhythm, such as a fast or skipping heartbeat.

Metabolism Changes. Invega Sustenna can cause high blood sugar levels or diabetes, high cholesterol levels, and weight gain. Keep all appointments with your health care provider to check your bloodwork and weight. Call your health care provider if you gain weight or have the following symptoms of high blood sugar.

  • Thirsty more than usual
  • Peeing more than usual
  • Increase in hunger
  • Tiredness
  • Feeling sick to your stomach
  • Confusion
  • Your breath smelling fruity

Uncontrolled Movements. Invega Sustenna can cause some people to have movements that they cannot control. This condition, called tardive dyskinesia (TD), can cause jerky movements of the face, tongue, or body. TD can be permanent. Call your health care provider right away if you have any of the following symptoms of TD.

  • Tongue sticking out
  • Lip smacking or puckering
  • Grimacing
  • Rapid eye blinking
  • Jerking or twisting motion of the arms, legs, or trunk

Low Blood Pressure Upon Standing (Orthostatic Hypotension) and Falls. Invega Sustenna may cause a sudden drop in blood pressure when you stand up from a seated or lying position. This may increase your risk of falling. To help prevent this, be careful not to get up too quickly. If you feel dizzy, sit or lie down right away until the dizziness stops, then take your time getting up again. Tell your health care provider right away if you have any of the following symptoms of orthostatic hypotension.

  • Dizziness, feeling lightheaded, or fainting upon standing
  • Blurred vision
  • Confusion
  • Feeling weak

Decreased Alertness or Coordination. Invega Sustenna can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how Invega Sustenna affects you.

Blood Disorders. Invega Sustenna can cause blood disorders, such as low white blood cell levels (leukopenia,  neutropenia, or agranulocytosis). Keep all appointments with your health care provider to check your bloodwork. Stop using Invega Sustenna and get help right away if you have any of the following symptoms of blood disorders.

  • Fever
  • Shortness of breath
  • Frequent infection
  • Unusual weakness or tiredness
  • Dizziness, lightheadedness, or feeling like you are about to pass out
  • Headache
  • Fast or abnormal heartbeat

Neuroleptic Malignant Syndrome (NMS). Antipsychotic medicines, like Invega Sustenna, may cause a rare but serious condition called neuroleptic malignant syndrome. NMS can lead to death. Stop using Invega Sustenna and contact your health care provider right away if you have any of the following symptoms.

  • High fever
  • Muscle stiffness or rigidity, where it is hard to move
  • Confusion 
  • Changes in your breathing or heart rate
  • Increased sweating

High Prolactin Level (Hyperprolactinemia). Invega Sustenna may cause an increased level of the hormone prolactin in your blood. High levels of prolactin could lead to fertility or bone problems. Contact your health care provider if you have any of the following symptoms.

  • Vaginal dryness
  • Irregular or no periods
  • Production of breast milk when not pregnant or nursing
  • Inability to get or keep an erection
  • Enlarged breast size (gynecomastia)
  • Decreased muscle and body hair

Painful, Prolonged Erection (Priapism). Invega Sustenna may cause an unwanted erection that is persistent, painful, and that may happen without sexual arousal. Permanent damage to the penis may occur if priapism is not treated quickly. Stop using Invega Sustenna and get emergency help right away if you have any of the following symptoms of priapism.

  • Erection lasting for more than four hours
  • Erection that is unrelated to sexual stimulation
  • Painful or tender penis

Body Temperature Regulation. Invega Sustenna can affect your ability to regulate your body temperature. This could make you become very hot, especially in hot weather or after exercising a lot. You should drink water and avoid overheating and dehydration. Call your health care provider right away if you are severely ill and have the following symptoms.

  • Excessive or no sweating
  • Dry mouth
  • Feeling very hot
  • Feeling thirsty
  • Not able to pee

Trouble Swallowing. Invega Sustenna can cause trouble swallowing (dysphagia), which can increase your risk of choking while eating or drinking. Eat small amounts of food, and chew your food well. Get emergency help if you are choking or have food stuck in your esophagus that is not passing.

Seizures. Some people who have used Invega Sustenna have reported having seizures. There are many types of seizures, and some of them are not easy to recognize. Stop using Invega Sustenna and call your health care provider if you have any of the following signs that a seizure is happening or could happen.

  • Muscle twitching, jerking, spasms, tremors, or other uncontrolled movements
  • Stiffening of your arms and legs
  • Feeling anxious, nervous, confused, or a sense of dread
  • Feeling dizzy or lightheaded
  • Falling or losing consciousness

Warnings & Precautions

Who should not use Invega Sustenna?

Allergies to Ingredients. People who are allergic to any of the following should not use Invega Sustenna.

  • Invega Sustenna
  • Paliperidone
  • Risperidone
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in Invega Sustenna.

What should I know about Invega Sustenna before using it?

Invega Sustenna is given to you by a health care provider in a hospital, clinic, or pharmacy. It is given as a shot in your arm or butt muscle once a month.

Before starting Invega Sustenna, your health care provider may check that you have taken paliperidone (the medicine in Invega Sustenna) or risperidone by mouth. This can help make sure you tolerate Invega Sustenna. 

Because Invega Sustenna can make it hard for you to regulate your body temperature, try to avoid becoming too hot or dehydrated. Drink plenty of water, limit your exposure to the heat and sun, do not overexercise, and wear light and breathable clothing.

If you can become pregnant, using Invega Sustenna may make this more difficult. These effects likely go away after you stop using Invega Sustenna. Talk to your health care provider if you have any concerns.

People who are 65 or older can be at greater risk of some side effects from Invega Sustenna. Talk to your health care provider about your risks if you are in this age group.

What should I tell my health care provider before using Invega Sustenna?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if Invega Sustenna is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have or have had any of the following.

  • Neuroleptic malignant syndrome (NMS)
  • Heart problems, including a heart attack, heart failure, an abnormal heart rhythm, or long QT syndrome 
  • Low potassium or magnesium levels
  • Kidney or liver problems
  • Tardive dyskinesia (such as grimacing, jerky movements, or lip smacking)
  • High or low blood pressure
  • Fainting or dizziness
  • Personal or family history of diabetes or high blood sugar
  • High cholesterol or triglyceride levels
  • High prolactin levels
  • Low white blood cell levels
  • Seizures or epilepsy

Psychosis Related to Dementia. There is a higher risk of death, stroke, or ministroke in older adults who use Invega Sustenna or another antipsychotic and have memory loss or psychosis related to dementia. Invega Sustenna is not approved to treat dementia-related psychosis.

Other Medicines and Supplements. Invega Sustenna may interact with other medicines and supplements. Before using Invega Sustenna, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. Invega Sustenna used later in pregnancy may lead to an increased risk of certain problems in your newborn. Tell your health care provider if you are pregnant or plan to become pregnant while using Invega Sustenna. Your health care provider will advise you if you should use Invega Sustenna while you are pregnant or trying to get pregnant. If you become pregnant while using Invega Sustenna, you can register with the National Pregnancy Registry for Atypical Antipsychotics by calling 866-961-2388 or at womensmentalhealth.org/research/pregnancyregistry. This registry collects safety information about the use of psychiatric medicines during pregnancy.

Breastfeeding. Invega Sustenna passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should use Invega Sustenna while breastfeeding.

How can I get more information about Invega Sustenna?

For more information about Invega Sustenna, you can visit the drugmaker’s website at www.injectionsforschizophrenia.com or call them at 800-526-7736.

Interactions

Does Invega Sustenna interact with foods or drinks?

There are no known interactions between Invega Sustenna and foods or drinks.

You should avoid drinking alcohol while using Invega Sustenna. The risk of dizziness and sleepiness may be increased if you drink alcohol while using Invega Sustenna.

Does Invega Sustenna interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using Invega Sustenna.

  • Any medicine that can cause QT prolongation, which is a potentially dangerous heart rhythm problem
  • A medicine for high blood pressure
  • An anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems
  • Carbamazepine (Carbatrol, Tegretol, and others), which is a medicine commonly used to treat seizures or nerve pain
  • Rifampin (Rifadin), which is a medicine commonly used to treat an infection called tuberculosis
  • St. John’s wort, which is a supplement that may be used for depression
  • A dopamine agonist, such as apomorphine (Apokyn), pramipexole (Mirapex ER), ropinirole, or rotigotine (Neupro), which is a medicine that may be used for Parkinson’s disease or restless legs syndrome (RLS)
  • Levodopa, which is a medicine commonly used for Parkinson’s disease
  • Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, and medicines for anxiety

Many other medicines may alter the blood levels of Invega Sustenna. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with Invega Sustenna. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much Invega Sustenna?

If you or someone else has used too much Invega Sustenna, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of Invega Sustenna?

It is important to try to avoid missing doses of Invega Sustenna. If you miss an appointment to get your Invega Sustenna dose, call to make another appointment as soon as possible. 

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