What should clinicians know about Invega Trinza (paliperidone palmitate 12-week LAI)?

Invega Trinza is a long-acting injectable (LAI) formulation of paliperidone. It is the first available antipsychotic LAI available that provides coverage for 12 weeks. It is FDA-indicated to treat adults with schizophrenia.

Establishing Efficacy and Tolerability

• Prior to initiating Invega Trinza, treat the patient with Invega Sustenna (1 month formulation of paliperidone palmitate) for at least 4 months to ensure optimal dosing. 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.

Dosing

• Once every 12 week intramuscular injection only, which must be administered by a healthcare provider.
• Available as single-dose prefilled syringes of the following doses:
  • 819 mg (injection volume of 2.625 ml)
  • 546 mg (injection volume of 1.75 ml)
  • 410 mg (injection volume of 1.315 ml)
  • 273 mg (injection volume of 0.875 ml)

    Dose Conversion of Oral Paliperidone to Paliperidone Palmitate 12-week LAI
    PO Dose	LAI/Invega Sustenna Dose **Stabilization with Invega Sustenna required prior to initiation of Invega Trinza	LAI/Invega Trinza Dose
    < 3 mg paliperidone	39 mg Invega Sustenna every 4 weeks	N/A
    3 mg paliperidone	78 mg Invega Sustenna every 4 weeks	273 mg Invega Trinza every 12 weeks
    6 mg paliperidone	117 mg Invega Sustenna every 4 weeks	410 mg Invega Trinza every 12 weeks
    9 mg paliperidone	156 mg Invega Sustenna every 4 weeks	546 mg Invega Trinza every 12 weeks
    12 mg paliperidone	234 mg Invega Sustenna every 4 weeks	819 mg Invega Trinza every 12 weeks
    Recommended available dose formulations include 273 mg, 410 mg, 546 mg, and 819 mg pre-filled syringes. Dose reduction may be necessary for CYP450 interactions of side effect intolerance. References: 1. Stahl, S. M. (2017). The prescriber’s guide: Stahl’s essential psychopharmacology (6th ed.). New York: Cambridge University Press. 2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841 3. INVEGA SUSTENNA USPI, Section 2.8: Instructions for Use; Section 17: How Supplied/Storage and Handling

• No loading dose or oral supplementation recommended because steady state plasma levels have been achieved by 4 months of Invega Sustenna.

Practical issues (including administration)

• Store Invega Trinza at room temperature.
• The thin-walled needles included in the Invega Trinza kit must be used for the injection.
• Shake the pre-filled syringe vigorously for 15 seconds with the syringe tip pointing up. Administer the injection within 5 minutes of shaking.
• Choose between the deltoid or gluteal muscle based on the patient preference and body habitus.
  • Rotate injection sites to avoid muscle hypertrophy, abscesses, and tissue damage by repeated, frequent injections at the same site.

FDA Medication Label

Information on this topic is found in the FDA medication label.  Prescribing should always be informed by the FDA medication label. Medication labels can be found by searching Drugs@FDA at the FDA website. Labels are also available using the Drugs@FDA app for Apple or Android devices.

Labels change over time, and the current label should always be consulted. Here is the most recent label, at time of writing.

Administraion/Dosing Guide

More information about administration (including a detailed video) and dosing can be found here.

REFERENCES

• INVEGA SUSTENNA USPI, Section 1: Indications and Usage