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This information is intended for US healthcare professionals to access current scientific information about J&J Innovative Medicine products. It is prepared by Medical Information and is not intended for promotional purposes, nor to provide medical advice.

INVEGA TRINZA® (paliperidone palmitate)

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Conversion of INVEGA TRINZA to INVEGA

Last Updated: 01/30/2025

Summary

Population pharmacokinetic (POP-PK) based simulations have been conducted to evaluate switching from INVEGA TRINZA injection to oral paliperidone extended-release (ER) tablets.¹
To switch from INVEGA TRINZA to INVEGA (paliperidone ER) tablets, the daily dosing of the INVEGA tablets should be started 3 months after the last INVEGA TRINZA dose and transitioned over the next several months following the last INVEGA TRINZA dose.¹
For complete product information that is relevant to this topic, please refer to the approved labeling.

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 from mg eq to mg is 1.56.

INVEGA TRINZA doses expressed as 273, 410, 546, and 819 mg of paliperidone palmitate are equal to 175, 263, 350, and 525 mg eq of paliperidone, respectively.

SWITCHING TO INVEGA

Please refer to the local labeling for complete information. For conversion regimens, see Table: INVEGA TRINZA Doses and Once-Daily INVEGA Conversion Regimens Needed to Attain Similar Paliperidone Exposures.

INVEGA TRINZA Doses and Once-Daily INVEGA Conversion Regimens Needed to Attain Similar Paliperidone Exposures¹

Last INVEGA TRINZA Dose	Weeks Since Last INVEGA TRINZA Dose
	3 months to 18 weeks	Longer than 18 weeks to 24 weeks	Longer than 24 weeks
	Doses of INVEGA tablets
273 mg	3 mg	3 mg	3 mg
410 mg	3 mg	3 mg	6 mg
546 mg	3 mg	6 mg	9 mg
819 mg	6 mg	9 mg	12 mg

PUBLISHED DATA

Conversion to INVEGA from INVEGA TRINZA Treatment

Gopal et al (2015)¹^,² conducted a POP-PK simulation to provide guidance on transitioning from INVEGA TRINZA to INVEGA in the event of INVEGA TRINZA discontinuation.

For switching from INVEGA TRINZA 819 mg to INVEGA, the transition regimen was simulated to start at least 3 months after the last INVEGA TRINZA dose.
- 6 mg/day of INVEGA: ≥12 weeks to ≤18 weeks since the last INVEGA TRINZA dose
- 9 mg/day of INVEGA: >18 weeks to ≤24 weeks since the last INVEGA TRINZA dose
- 12 mg/day of INVEGA: >24 weeks since the last INVEGA TRINZA dose
This transition regimen with INVEGA provided similar exposures to paliperidone after discontinuation of INVEGA TRINZA treatment, although concentrations approached apparent steady-state gradually since the absorption process went on for several months after the last 819 mg INVEGA TRINZA dose.
These simulations illustrate that for switching from INVEGA TRINZA to INVEGA tablets, the daily dosing of the INVEGA tablets should be started 3 months after the last INVEGA TRINZA dose and transitioned gradually over the next several months following the last INVEGA TRINZA dose. See Figures: Transition From 273 mg INVEGA TRINZA to 3 mg INVEGA, Transition From 410 mg INVEGA TRINZA to 6 mg INVEGA, Transition From 546 mg INVEGA TRINZA to 9 mg INVEGA, and Transition From 819 mg INVEGA TRINZA to 12 mg INVEGA.

Transition From 273 mg INVEGA TRINZA to 3 mg INVEGA^a,¹

Abbreviations: ER, extended release.
^aThe solid lines and shaded areas represent the median paliperidone concentrations and 90% prediction intervals, respectively, after transition from 273 mg injections of INVEGA TRINZA to INVEGA 3 mg daily at Weeks 65, 71, and 77.

Transition From 410 mg INVEGA TRINZA to 6 mg INVEGA^a,¹

Abbreviations: ER, extended release.
^aThe solid lines and shaded areas represent the median paliperidone concentrations and 90% prediction intervals, respectively, after transition from 410 mg injections of INVEGA TRINZA to INVEGA 3 mg daily at Weeks 65 and 71, and 6 mg at Week 77.

Transition From 546 mg INVEGA TRINZA to 9 mg INVEGA^a,¹

Abbreviations: ER, extended release.
^aThe solid lines and shaded areas represent the median paliperidone concentrations and 90% prediction intervals, respectively, after transition from 546 mg injections of INVEGA TRINZA to INVEGA 3 mg daily at Week 65, 6 mg daily at Week 71 and 9 mg daily at Week 77.

Transition From 819 mg INVEGA TRINZA to 12 mg INVEGA^a,¹

Abbreviations: ER, extended release.
^aThe solid lines and shaded areas represent the median paliperidone concentrations and 90% prediction intervals, respectively, after transition from 819 mg injections of INVEGA TRINZA to INVEGA 6 mg daily at Week 65, 9 mg daily at Week 71 and 12 mg daily at Week 77.

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 08 January 2025.

References

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1	Gopal S, Vermeulen A, Nandy P, et al. Population pharmacokinetic simulations of dosing windows and missed doses of paliperidone palmitate 3-month formulation in schizophrenia. Poster presented at: The American Psychiatric Association Annual Meeting; May 16-20, 2015; Toronto, Canada.
2	Magnusson MO, Samtani MN, Plan EL, et al. Dosing and switching strategies for paliperidone palmitate 3-month formulation in patients with schizophrenia based on population pharmacokinetic modeling and simulation, and clinical trial data. CNS Drugs. 2017;31(4):273-288.