paliperidone

General information

• Class: Antipsychotic
• Common US brands: INVEGA, INVEGA SUSTENNA, INVEGA TRINZA, INVEGA HAFYERA
• Typical dose range: Paliperidone extended-release tablets: start 6 mg once daily; adjust 3–12 mg/day (max 12 mg/day; adolescents start at 3 mg daily).
• Long-acting injectable formulation available.
• Therapeutic drug monitoring not routinely recommended.
• Last reviewed: 2026-03-31

Dosing & forms

• Forms/strengths: Paliperidone extended-release (OROS) tablets: 1.5 mg, 3 mg, 6 mg, 9 mg, 12 mg once daily without cyclic titration.; Paliperidone palmitate LAIs: Sustenna (39–234 mg monthly), Trinza (273–819 mg quarterly), Hafyera (1,092–1,560 mg every 6 months); max doses 234 mg, 819 mg, and 1,560 mg per interval.
• Frequency: Paliperidone extended-release tablets: start 6 mg once daily; adjust 3–12 mg/day (max 12 mg/day; adolescents start at 3 mg daily).
• Typical range: Paliperidone extended-release tablets: start 6 mg once daily; adjust 3–12 mg/day (max 12 mg/day; adolescents start at 3 mg daily).

Mechanism (brief)

D2 and 5‑HT2A antagonism; active metabolite of risperidone.

Metabolism & Half‑life

• Metabolism: Minimal hepatic metabolism; largely excreted unchanged
• Half‑life: Steady-state mean 23 h

Therapeutic Drug Monitoring (TDM)

Recommended: No

Long‑acting injectable (LAI)

Sources

• INVEGA (paliperidone) extended-release tablets prescribing information — DailyMed (2025)
• The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia — American Psychiatric Association (2020)
• AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology — Pharmacopsychiatry (2018)
• Paliperidone palmitate maintenance treatment in delaying time to relapse in patients with schizophrenia — Schizophrenia Research (2010)
• Efficacy and Safety of the 3-Month Formulation of Paliperidone Palmitate vs Placebo for Relapse Prevention of Schizophrenia: A Randomized Clinical Trial — JAMA Psychiatry (2015)