Both initiation doses must be given in the deltoid muscle1

  • For patients who have not taken oral paliperidone, oral risperidone, or injectable risperidone, establish tolerability first1
  • Previous oral antipsychotics can be gradually discontinued upon starting INVEGA SUSTENNA®1
  • To avoid a missed dose, patients may be given the second initiation dose within a ± 4-day flexible window1


First monthly maintenance dose should be administered 5 weeks after the first injection (regardless of the timing of the second injection)1

  • To avoid a missed dose, monthly maintenance doses may be given within a ± 7-day flexible window
  • Utilizing the maintenance dosing window to help avoid missed doses should be considered the exception rather than the rule

*The recommended maintenance dose for the treatment of schizophrenia is 117 mg. Some patients may benefit from lower or higher maintenance doses within the additional available strengths (39 mg, 78 mg, 156 mg, and 234 mg).

Administration and plasma levels

Ensure the 2 initiation doses are given in the deltoid to help attain rapid plasma levels1,2

Deltoid vs gluteal injection:
Comparison of paliperidone plasma concentrations following a single injection1,2
Chart of Deltoid v. Gluteal Injection

Following intramuscular injection of single doses (39 mg-234 mg) in the deltoid muscle, a 28% higher Cmax (on average) was observed compared with injection in the gluteal muscle.

The initiation regimen for INVEGA SUSTENNA® (234 mg/day 1 and 156 mg/day 8 both in the deltoid muscle) was designed to rapidly attain steady-state paliperidone concentrations when initiating therapy without the use of oral supplementation.1

Administration notes

  • Each injection must be administered by a healthcare professional1
  • Shake the prefilled syringe for at least 10 seconds before administering1
  • Select appropriate needle size depending on patient’s weight and injection location1

See the Educational Dose Illustrator

Could your patients living with schizophrenia, who have been adequately treated with INVEGA SUSTENNA® for at least 4 months, benefit from the longest dosing interval available? Learn how to dose 4 times a year with INVEGA TRINZA® (paliperidone palmitate).3


Contraindications: Paliperidone is contraindicated in patients with a known hypersensitivity to either paliperidone, risperidone, or to any excipients of the formulation.

References: 1. INVEGA SUSTENNA® [prescribing information]. Titusville, NJ: Janssen Pharmaceuticals, Inc.; March 2018. 2. Data on file. Janssen Pharmaceuticals, Inc., Titusville, NJ. 3. INVEGA TRINZA® [prescribing information]. Titusville, NJ: Janssen Pharmaceuticals, Inc.; March 2018.