| Schizophrenia; acute manic or mixed episodes of bipolar I disorder (monotherapy or adjunct to lithium/valproate); maintenance therapy via LAI formulations; adjunctive treatment of major depressive disorder; irritability in autistic disorder; Tourette disorder. View labelExact | Schizophrenia (adults): start 10–15 mg once daily; therapeutic range 10–30 mg/day. Doses above 30 mg rarely add benefit. | Dopamine D2/D3 partial agonist with 5-HT1A partial agonism and 5-HT2A antagonism, stabilizing dopaminergic tone with comparatively low metabolic and EPS burden.
| CYP2D6, CYP3A4 | Steady-state mean 75 h; Steady-state range 75–146 h | 120–270 ng/mL | | - Metabolic: weight/BMI, fasting glucose/HbA1c, and lipids (baseline and periodic).
- EPS: monitor akathisia/parkinsonism; periodic AIMS for tardive dyskinesia.
| Monthly (q4wk); q4–8wk (varies by strength); Every 2 months (q8wk) | 2025-12-28 |
|---|
paliperidoneAntipsychoticBrands: INVEGA, INVEGA SUSTENNA, INVEGA TRINZA, INVEGA HAFYERA | Schizophrenia; schizoaffective disorder. View labelExact | Paliperidone extended-release tablets: start 6 mg once daily; adjust 3–12 mg/day (max 12 mg/day; adolescents start at 3 mg daily). | D2 and 5‑HT2A antagonism; active metabolite of risperidone. | Minimal hepatic metabolism; largely excreted unchanged | Steady-state mean 23 h | No | | - Metabolic: weight/BMI, fasting glucose/HbA1c, and lipids (baseline and periodic).
- EPS: monitor akathisia/parkinsonism; periodic AIMS for tardive dyskinesia.
- Prolactin: monitor for symptoms (amenorrhea, galactorrhea, sexual dysfunction).
| Monthly / q3mo / q6mo | 2026-03-31 |
|---|
| Schizophrenia; acute mania or mixed episodes (bipolar I) as monotherapy or adjunct; irritability associated with autistic disorder. View labelExact | Schizophrenia (adults): start 1–2 mg/day; increase by 1–2 mg/day to 4–6 mg/day (doses >6 mg/day increase EPS). | Dopamine D2 and serotonin 5‑HT2A receptor antagonism; also alpha‑1 and H1 activity. | CYP2D6 | Single-dose mean 3 h; Steady-state mean 21 h | No | - Weight
- Sedation
- EPS
- Prolactin
| - Metabolic: weight/BMI, fasting glucose/HbA1c, and lipids (baseline and periodic).
- EPS: monitor akathisia/parkinsonism; periodic AIMS for tardive dyskinesia.
- Prolactin: monitor for symptoms (amenorrhea, galactorrhea, sexual dysfunction).
- Sedation: assess next-day impairment and fall risk, especially with other sedatives.
| q2wk; Monthly (q4wk); q4wk or q8wk (by dose) | 2025-12-28 |
|---|
| Schizophrenia; severe behavior disorders; Tourette's syndrome (tics/vocal utterances); adjunct in acute agitation. View labelExact | Schizophrenia (oral): initiate 1–5 mg two or three times daily; maintenance 5–20 mg/day divided; doses >30 mg/day increase EPS risk. | Potent dopamine D2 receptor antagonist; minimal anticholinergic. | CYP3A4, CYP2D6 | Steady-state mean 21 h | No | | - Extrapyramidal symptoms are monitored periodically; prophylaxis is generally reserved for clear need.
- QTc: ECG monitoring is often considered when risk factors or higher doses are present.
- LAI: Haloperidol decanoate every 4 weeks—product-specific conversion guidance is typically used.
- Regular AIMS screening for tardive dyskinesia (typically every 3–6 months; every 3 months in higher-risk groups or with dose increases).
- Prolactin-related symptoms (sexual dysfunction, amenorrhea, galactorrhea) and overall quality-of-life impact—consider switching if persistent.
- Orthostatic vitals and falls risk, especially in older adults and when combined with other CNS depressants or antihypertensives.
- Metabolic monitoring (weight/BMI, glucose, lipids) periodically as part of comprehensive schizophrenia care, even though metabolic risk is lower than many SGAs.
| q4wk | 2026-03-31 |
|---|