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Summary
- The published literature provides mixed information on the maximum injection volume that should be used to ensure safe and tolerable delivery of medications by deltoid intramuscular (IM) injection. Some authors consider 1 mL and others consider 2 mL to be the maximum injection volume that is safe for deltoid IM injection.1-11
- The highest available dosage strength (volume) of INVEGA SUSTENNA studied in clinical trials is 234 mg (1.5 mL).12-14
VOLUME OF INJECTION
INVEGA SUSTENNA is supplied in prefilled syringes with a concentration of 156 mg/mL of paliperidone palmitate. Each syringe contains the correct volume for injection based on the dose of INVEGA SUSTENNA. Table: Volume of Injection Per Dose of INVEGA SUSTENNA provides specific information related to the volume of INVEGA SUSTENNA in each syringe.14
Volume of Injection Per Dose of INVEGA SUSTENNA14
|
|
|---|
39 mg
| 0.25 mL
|
78 mg
| 0.5 mL
|
117 mg
| 0.75 mL
|
156 mg
| 1 mL
|
234 mg
| 1.5 mL
|
BACKGROUND
The published literature provides mixed information on the maximum injection volume that is safe for deltoid muscle administration. Because the deltoid is a small and sometimes poorly developed muscle, injections should be given in the densest part of the muscle.7,15,16 Furthermore, because the deltoid injection site is relatively small and is proximal to the axillary and radial nerves, the precise location of the injection site is important, and the volume that should be used to ensure safe delivery is limited.1,5-7,17-20
A review of the published literature regarding appropriate volumes for deltoid muscle administration in adults varies, and several are summarized in Table: Published Information Applicable to Deltoid Injection Volume. As the table illustrates, some authors consider 1 mL and others consider 2 mL to be the maximum volume that is safe for deltoid intramuscular injection. The information listed in the table is not specific to studies of paliperidone palmitate; it is general information intended for any medication that is approved for deltoid intramuscular injection in adults.
Published Information Applicable to Deltoid Injection Volume
|
|
|---|
≤2 mL
| Nicoll 20021; Karch 20092; Perry 201311; Lala 20035
|
1 mL to 2 mL
| Hunt 20086
|
0.5 mL to 2 mL
| Cocoman 20087; Rosdahl 20084; Feetam 201121
|
0.1 mL to 2 mL
| Newton 19928
|
≤1 mL
| Covington 19979
|
0.5 mL to 1 mL
| Beyea 199610
|
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 18 April 2024.
| 1 | Nicoll LH, Hesby A. Intramuscular injection: an integrative research review and guideline for evidence-based practice. Appl Nurs Res. 2002;15(3):149-162. |
| 2 | Karch AM. Lippincott’s nursing drug guide. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012. |
| 3 | Anonymous. Intramuscular injections. Nurs Times. 2003;99:27. |
| 4 | Rosdahl C, Kowalski M. Textbook of basic nursing. 9th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008:855. |
| 5 | Lala K, Lala M. Intramuscular injection: review and guidelines. Indian Pediatr. 2003;40:835-845. |
| 6 | Hunt C. Which site is best for an IM injection? Nursing. 2008;38(11):62. |
| 7 | Cocoman A, Murray J. Intramuscular injections: a review of best practice for mental health nurses. J Psychiatr Ment Health Nurs. 2008;15(5):424-434. |
| 8 | Newton M, Newton DW, Fudin J. Letter structure factors in the recognition of alphabetical arrays presented in the right and left visual fields. Percept Motor Skill. 1970;31(2):555-559. |
| 9 | Covington TP, Trattler MR. Translational research: basic mechanisms. Epilepsia. 2005;46(1):91-131. |
| 10 | Beyea SC, Nicoll LH. Evolution strategies. Proceedings of the 13th annual conference companion on Genetic and evolutionary computation - GECCO ’11. 2011;96(1):875-898. |
| 11 | Perry A, Potter P, Ostendor W. Clinical nursing skills and techniques. In: 22-3. 8th ed. St. Louis, MO: Elsevier Mosby; 2013:563-564. |
| 12 | Pandina GJ, Lindenmayer JP, Lull J, et al. A randomized placebo-controlled study to assess the efficacy and safety of 3 doses of paliperidone palmitate in adults with acutely exacerbated schizophrenia. J Clin Psychopharmacol. 2010;30(3):235-244. |
| 13 | Gopal S, Hough DW, Xu H, et al. Efficacy and safety of paliperidone palmitate in adult patients with acutely symptomatic schizophrenia: a randomized, double-blind, placebo-controlled, dose-response study. Int Clin Psychopharmacol. 2010;25(5):247-256. |
| 14 | Citrome L. Paliperidone palmitate - review of the efficacy, safety and cost of a new second‐generation depot antipsychotic medication. Int J Clin Pract. 2010;64(2):216-239. |
| 15 | Rodger MA, King L. Drawing up and administering intramuscular injections: a review of the literature. J Adv Nurs. 2000;31(3):574-582. |
| 16 | Carter-Templeton H, McCoy T. Are we on the same page?: a comparison of intramuscular injection explanations in nursing fundamental texts. Medsurg Nurs. 2008;17(4):237-240. |
| 17 | Chaturvedi P. Intramuscular injections. Indian J Pediatr. 1985;52(418):445-448. |
| 18 | Beyea SC, Nicoll LH. Administration of medications via the intramuscular route: an integrative review of the literature and research-based protocol for the procedure. Appl Nurs Res. 1995;8(1):23-33. |
| 19 | Wynaden D, Landsborough I, McGowan S, et al. Best practice guidelines for the administration of intramuscular injections in the mental health setting. Int J Ment Health Nurs. 2006;15(3):195-200. |
| 20 | Hunter J. Intramuscular injection techniques. Nurs Stand. 2008;22(24):35-40. |
| 21 | Feetam C, White A. Guidance on the administration to adults of oil-based depot and other long-acting intramuscular antipsychotic injections 6th edition (2020). Accessed 2024-04-18. https://hull-repository.worktribe.com/output/3632150 |
