Summary

• INVEGA SUSTENNA is to be administered in the deltoid muscle during initiation and either the deltoid or gluteal muscle during maintenance treatment.¹
• A 25-year-old male with bipolar disorder presenting with erratic behavior and delusions was administered INVEGA SUSTENNA into the vastus lateralis (thigh muscle). No improvement in delusions was noted by day 7.²

DOSAGE STRENGTH INFORMATION

Doses of paliperidone palmitate extended-release injectable suspension may be expressed in milligram equivalents of paliperidone (active moiety) or milligrams of paliperidone palmitate. Dosage information in this response has been converted to mg of paliperidone palmitate to reflect the commercially available dosage strengths available in the United States. The conversion factor from mg eq. to mg is 1.56.

• INVEGA SUSTENNA doses expressed as 39, 78, 117, 156, and 234 mg of paliperidone palmitate are equal to 25, 50, 75, 100, and 150 mg eq., respectively.

CASE REPORT

Funk et al (2013)² reported a case of a 25-year-old male with bipolar disorder who presented to the emergency room with erratic behavior and delusions. After ensuring tolerability with oral paliperidone, INVEGA SUSTENNA 234 mg was administered on day 1 into the vastus lateralis (thigh muscle) by error. By day 7, no improvement in delusions was noted. The second initiation dose of INVEGA SUSTENNA was withheld on day 8 and fluphenazine decanoate 12.5 mg was administered in the deltoid muscle 10-14 days following the first paliperidone palmitate dose with symptom improvement. No pharmacokinetic data was collected. The authors note it is unclear if continued symptoms were due to medication non-response or decreased absorption at the vastus lateralis site of injection.

LITERATURE SEARCH

A literature search of MEDLINE^®, EMBASE^®, BIOSIS Previews^®, and DERWENT Drug File (and/or other resources, including internal/external databases) pertaining to this topic was conducted on 21 August 2024.