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.
Dosing available as prefilled syringes
273 mg (injection volume of 0.875 ml)
Recommended starting and maintenance dose
Used only after establishment of four months of Invega Sustenna once monthly injection (last 2 months with the same dose); dose based on Invega Sustenna IM once monthly dose
Invega Trinza is not recommended in patients with moderate or severe renal impairment
Dose equivalence to Sustenna:
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.
Reconsititution or mixing
No reconstitution required
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.
Every 12 weeks
With the syringe tip pointing up, shake vigorously with a loose wrist for at least 15 seconds to ensure a homogeneous suspension. If more than 5 minutes pass before injection, shake vigorously, with the syringe tip pointing up, again for at least 15 second to re-suspend the medication. Priming the syringe is recommended.
Inject the entire contents intramuscularly slowly, deep into the selected deltoid or gluteal muscle of the patient.
To avoid a missing dose: patients may be given the injection up to 2 weeks before or after the 3-month time point.
When a dose is missed
If a patient has missed a dose and it is 3.5 months to 4 months since last injection: the previously administered Trinza dose should be administered as soon as possible, then continue with the 3-month injections following the dose.
If 4 months to 9 months since last injection: This requires re-initiation via table 2 in the package insert.
Dose Conversion of Oral Paliperidone to Paliperidone Palmitate 12-week LAI
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
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.
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.
More information about administration (including a detailed video) and dosing can be found here.