Summary

• INVEGA SUSTENNA is not approved for the treatment of psychosis induced by traumatic brain injury (TBI).
• A case report has described the use of INVEGA SUSTENNA to treat post TBI psychosis.¹

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 milligrams of paliperidone palmitate to reflect the commercially available dosage strengths in the United States. The conversion factor 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 of paliperidone, respectively.

Case report

A 56-year-old African American male was involuntarily admitted to the Veterans Affairs medical center due to paranoia, increased outbursts, and aggression. Past medical history included hypertension, hyperlipidemia, vitamin D deficiency, TBI from a motor vehicle accident and seizure disorder post-TBI (treated with divalproex DR 750 mg twice daily and topiramate 200 mg twice daily). The patient's seizures were uncontrolled, but valproic acid levels measured on admission showed compliance with treatment. Psychotic disorder due to another medical condition with delusions was ruled out. The patient was previously admitted for behavioral disturbances secondary to TBI. During his second stay, he was given risperidone up to 6 mg/day, but was tapered prior to discharge due to medication refusal.¹

Upon admission, the patient’s behavior was attributed to post-TBI psychosis and he was started on risperidone 1mg daily; however, this treatment was consistently refused. The patient remained paranoid, argumentative, and delusional during the first 2 weeks of his hospital stay. He experienced a seizure on hospital day (HD) 2, but refused medication adjustment because he was paranoid that medical staff were plotting in an attempt to keep him hospitalized.¹

On HD 15, INVEGA SUSTENNA 234 mg was administered to the patient. Based on daily interviews by the attending psychiatrist and nursing reports, there was an improvement in symptoms within a week of the first injection. The patient’s paranoia lessened, and he accepted the next injections of INVEGA SUSTENNA 156 mg on HDs 22 and 50. The patient experienced a second seizure on HD 24 and a possible third seizure on HD 62. It is unknown whether this patient’s seizures were medication-related due to his history of uncontrolled epilepsy. No other acute neurological, psychiatric, or adverse medication events were documented.¹

LITERATURE SEARCH

A literature search of MEDLINE^®, EMBASE^®, BIOSIS Previews^®, DERWENT Drug File (and/or other resources, including internal/external databases) pertaining to this topic was conducted on 20 January 2025.