Transition from Any Other Long‑Acting Injectable (LAI) Antipsychotic to INVEGA SUSTENNA® to INVEGA TRINZA®

  • Legend
    • initiation-dosing-symbol

      Initiation Doses

    • maintenace-dose-symbol

      Maintenance Doses

    • legend-pp1m-plasma-concentration

      Cumulative INVEGA SUSTENNA® Plasma Concentration

    • legend-pp3m-plasma-concentration

      Cumulative INVEGA TRINZA® Plasma Concentration

    • legend-er-plasma-concentration

      Cumulative Oral INVEGA® ER Plasma Concentration

    • legend-er-doses

      Daily Oral INVEGA® Doses

    • legend-rl-dose-symbol

      Cumulative RISPERDAL CONSTA® Plasma Concentration

    • median-plasma-concentration-symbol

      Median Plasma Concentration for Oral INVEGA® ER 6-12 mg/day

    • initiation-dosing-symbol

      Initiation Doses

    • maintenace-dose-symbol

      Maintenance Doses

    • legend-old-browser-paliperidone-palmitate-concentration

      Cumulative Paliperidone Palmitate Concentration

    • legend-er-doses

      Daily Oral INVEGA® ER Dose

    • legend-rl-dose-symbol-greyscale

      Cumulative RISPERDAL CONSTA® Plasma Concentration

    • Week 1 = Day 8

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Typical Paliperidone Plasma Concentration (ng/mL)
Typical Paliperidone Plasma Concentration (ng/mL)
Dose Information

Dosage Strength: According to the INVEGA TRINZA® Prescribing Information, patients who are treated with any other LAI product (other than INVEGA SUSTENNA® or RISPERDAL CONSTA®) should be transitioned to 234 mg of INVEGA SUSTENNA®.

Dosage Location: When patients in the INVEGA TRINZA® clinical trial switched from any other LAI product to INVEGA SUSTENNA®, the site of injection for the first INVEGA SUSTENNA® dose was in the deltoid muscle.

Dosage Strength: The recommended maintenance dosage strength for the treatment of schizophrenia is 117 mg per the INVEGA SUSTENNA® Prescribing Information. Some patients may benefit from lower or higher maintenance doses within the additional available strengths (39 mg, 78 mg, 156 mg, and 234 mg). For illustrative purposes only, the INVEGA SUSTENNA® maintenance dosage strength may be adjusted by one dose increment down from the previous dose administered.

Dosage Location: The INVEGA SUSTENNA® monthly maintenance doses can be administered in either the deltoid or gluteal muscle per the INVEGA SUSTENNA® Prescribing Information. For illustrative purposes only, once you select the deltoid or gluteal muscle for an INVEGA SUSTENNA® maintenance dose, the site of injection will remain constant for all remaining INVEGA SUSTENNA® maintenance doses.

Dosage Timing: While the INVEGA SUSTENNA® Prescribing Information does permit a dosing window of ±7 days to help avoid a missed monthly dose, for illustrative purposes, the timing of the INVEGA SUSTENNA® maintenance doses cannot be adjusted.

Dosage Strength: For illustrative purposes only, the INVEGA SUSTENNA® maintenance dosage strength may be adjusted by one dose increment up or down from the previous dose administered.

Dosage Location: For illustrative purposes only, once you select the deltoid or gluteal muscle for an INVEGA SUSTENNA® maintenance dose, the site of injection will remain constant for all remaining INVEGA SUSTENNA® maintenance doses.

Dosage Timing: While the INVEGA SUSTENNA® Prescribing Information does permit a dosing window of ±7 days to help avoid a missed monthly dose, for illustrative purposes, the timing of the INVEGA SUSTENNA® maintenance doses cannot be adjusted.

Dosage Strength: The last two doses of INVEGA SUSTENNA® must be the same dosage strength in order to establish a consistent maintenance dose before starting INVEGA TRINZA®, as recommended per the INVEGA TRINZA® Prescribing Information.

Dosage Location: For illustrative purposes only, once you select the deltoid or gluteal muscle for an INVEGA SUSTENNA® maintenance dose, the site of injection will remain constant for all remaining INVEGA SUSTENNA® maintenance doses.

Dosage Timing: While the INVEGA SUSTENNA® Prescribing Information does permit a dosing window of ±7 days to help avoid a missed monthly dose, for illustrative purposes, the timing of the INVEGA SUSTENNA® maintenance doses cannot be adjusted.

Dosage Strength: The first INVEGA TRINZA® dose is determined by the consistent INVEGA SUSTENNA® maintenance dose, using the equivalent 3.5-fold higher INVEGA TRINZA® dosage strength per the INVEGA TRINZA® Prescribing Information. Adjustment to the final INVEGA SUSTENNA® maintenance doses will adjust all INVEGA TRINZA® dosage strengths.

Dosage Location: The INVEGA TRINZA® dose can be administered in either the deltoid or gluteal muscle per the INVEGA TRINZA® Prescribing Information.

Dosage Timing: For illustrative purposes only, the timing of the first INVEGA TRINZA® dose cannot be adjusted. However, the INVEGA TRINZA® Prescribing Information does allow the first INVEGA TRINZA® dose to be administered ±7 days of the next scheduled INVEGA SUSTENNA® dose.

Dosage Strength: For illustrative purposes only, the INVEGA TRINZA® maintenance dosage strength will remain constant for all INVEGA TRINZA® maintenance doses. INVEGA TRINZA® dosage adjustments can be made every 3 months in increments within the range of 273 mg to 819 mg based on individual patient tolerability and/or efficacy per the INVEGA TRINZA® Prescribing Information.

Dosage Location: For illustrative purposes only, once you select the deltoid or gluteal muscle for an INVEGA TRINZA® maintenance dose, the site of injection will remain constant for all remaining INVEGA TRINZA® maintenance doses.

Dosage Timing: While the INVEGA TRINZA® Prescribing Information does permit a dosing window of ±2 weeks to help avoid a missed dose, for illustrative purposes, the timing of the INVEGA TRINZA® maintenance dose cannot be adjusted.

Dosage Strength: For illustrative purposes only, the INVEGA TRINZA® maintenance dosage strength will remain constant for all INVEGA TRINZA® maintenance doses. INVEGA TRINZA® dosage adjustments can be made every 3 months in increments within the range of 273 mg to 819 mg based on individual patient tolerability and/or efficacy per the INVEGA TRINZA® Prescribing Information.

Dosage Location: For illustrative purposes only, once you select the deltoid or gluteal muscle for an INVEGA TRINZA® maintenance dose, the site of injection will remain constant for all remaining INVEGA TRINZA® maintenance doses.

Dosage Timing: While the INVEGA TRINZA® Prescribing Information does permit a dosing window of ±2 weeks to help avoid a missed dose, for illustrative purposes, the timing of the INVEGA TRINZA® maintenance dose cannot be adjusted.

Dosage Strength: For illustrative purposes only, the INVEGA TRINZA® maintenance dosage strength will remain constant for all INVEGA TRINZA® maintenance doses. INVEGA TRINZA® dosage adjustments can be made every 3 months in increments within the range of 273 mg to 819 mg based on individual patient tolerability and/or efficacy per the INVEGA TRINZA® Prescribing Information.

Dosage Location: For illustrative purposes only, once you select the deltoid or gluteal muscle for an INVEGA TRINZA® maintenance dose, the site of injection will remain constant for all remaining INVEGA TRINZA® maintenance doses.

Dosage Timing: While the INVEGA TRINZA® Prescribing Information does permit a dosing window of ±2 weeks to help avoid a missed dose, for illustrative purposes, the timing of the INVEGA TRINZA® maintenance dose cannot be adjusted.

Graph Information

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Transition to INVEGA TRINZA® from Any Other LAI Antipsychotic (Any Other LAI Antipsychotic to INVEGA SUSTENNA® to INVEGA TRINZA®)

Consistent with the INVEGA TRINZA® Prescribing Information:

  • Clinically stable patients entering the INVEGA TRINZA® long-term maintenance study who were being treated with a long-acting injectable antipsychotic product (other than RISPERDAL CONSTA®) were transitioned to 234 mg of INVEGA SUSTENNA® administered in the deltoid muscle in place of the next scheduled injection.
  • INVEGA TRINZA® is to be used only after INVEGA SUSTENNA® has been established as adequate treatment for at least four months. Adjust the INVEGA SUSTENNA® dose (78 mg, 117 mg, 156 mg, or 234 mg) according to efficacy/tolerability needs of the patient. Conversion from the INVEGA SUSTENNA® 39 mg dose was not studied.
  • In order to establish a consistent maintenance dose, it is recommended that the last two doses of INVEGA SUSTENNA® be the same dosage strength before starting INVEGA TRINZA®.
  • Initiate INVEGA TRINZA® when the next INVEGA SUSTENNA® is scheduled with an INVEGA TRINZA® dose based on the previous INVEGA SUSTENNA® dose, using the equivalent 3.5-fold higher dose as shown in table below.

INVEGA TRINZA® Doses for Adult Patients Adequately Treated with INVEGA SUSTENNA®

If the Last Dose of INVEGA SUSTENNA® is:

Initiate INVEGA TRINZA® at the Following Dose:

78 mg

273 mg

117 mg

410 mg

156 mg

546 mg

234 mg

819 mg

Conversion from the INVEGA SUSTENNA® 39 mg dose was not studied.

  • INVEGA TRINZA® should be administered every 3 months.
  • If needed, dose adjustment can be made every 3 months in increments within the range of 273 mg to 819 mg based on individual patient tolerability and/or efficacy. Due to the long-acting nature of INVEGA TRINZA®, the patient’s response to an adjusted dose may not be apparent for several months.
  • In a long-term placebo-controlled randomized-withdrawal trial, the percentages of patients with schizophrenia entering the double-blind phase on each of the INVEGA TRINZA® dosage strengths were 4% for 273 mg, 9% for 410 mg, 49% for 546 mg, and 38% for 819 mg.
  • Since other LAI antipsychotics (other than RISPERDAL CONSTA®) are not related to the paliperidone compound, the cumulative plasma level curve will not reflect the plasma level contributions from the previous LAI antipsychotic treatment in this scenario.
  • Administration: For intramuscular injection only by a healthcare professional. Care should be taken to avoid inadvertent injection into a blood vessel.

INVEGA TRINZA® Prescribing Information [http://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/INVEGA+TRINZA-pi.pdf]
INVEGA SUSTENNA® Prescribing Information [http://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/INVEGA+SUSTENNA-pi.pdf]

Educational Dose Illustrator for:
INVEGA SUSTENNA® (paliperidone palmitate)
INVEGA TRINZA® (paliperidone palmitate)

The Educational Dose Illustrator can be used to visualize how dosing affects paliperidone plasma concentrations following administration of:

INVEGA SUSTENNA® for:

  • the treatment of schizophrenia in adults
  • the treatment of schizoaffective disorder in adults as monotherapy and as an adjunct to mood stabilizers or antidepressants

INVEGA TRINZA® for:

  • the treatment of schizophrenia in patients after they have been adequately treated with INVEGA SUSTENNA® for at least four months.

This resource simulates the paliperidone plasma concentrations over time resulting from different dosing scenarios that are set forth in the respective Prescribing Information for INVEGA SUSTENNA® and INVEGA TRINZA®. The Educational Dose Illustrator is intended to be used as a resource to foster a better understanding of, and educate healthcare professionals about, the dosing recommendations provided in the respective Prescribing Information for INVEGA SUSTENNA® and INVEGA TRINZA®. It is intended for educational purposes only.

Because the simulated patient paliperidone plasma levels shown in the dosing scenarios are based upon aggregated pharmacokinetic information from clinical studies, the simulations may not be representative of individual patient response.

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