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 Tolerability

  • Prior to initiating Invega Trinza, treat the patient with Invega Sustenna (1 month formulation of paliperidone palmitate) for 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 prefilled syringes of the following doses:
    • 819 mg corresponds to a daily dose of paliperidone 12 mg or a q4 week injection of Invega Sustenna 234 mg
    • 546 mg corresponds to a daily dose of paliperidone 9 mg or a q4 week injection of Invega Sustenna 156 mg
    • 410 mg corresponds to a daily dose of paliperidone 6 mg or a q4 week injection of Invega Sustenna 117 mg
    • 273 mg corresponds to a daily dose of paliperidone 3 mg or a q4 week injection of Invega Sustenna 78 mg

      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 vial kits.

      Dose reduction may be necessary for CYP450 interactions of side effect intolerance.

      Reference: Stahl, S. M. (2017). The prescriber’s guide: Stahl’s essential psychopharmacology (6th ed.). New York: Cambridge University Press.

  • 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 must be used for the injection.
  • Shake the pre-filled syringe vigorously for 15 seconds. 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.

If you would like more information on this topic, or would like to provide any feedback, please send us a message using our consultation system. Be sure to let us know about which tip you are writing. We would love to hear from you, and the consultation system is free to use and confidential. Thank you!
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