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Tips for tapering off Invega (paliperidone)


Altostrata

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ADMIN NOTE Also see Dose Equivalents for Second-Generation Antipsychotics

 

Shiyun, 2012 Paliperidone palmitate injection for the acute and maintenance treatment of schizophrenia in adults


 

As with other psychiatric drugs, do not taper paliperidone by taking a dose every other day! This causes a fluctuating level of the drug in your nervous system and can make you very sick.

To minimize the risk of withdrawal symptoms, we recommend a conservative taper of 10% from the previous dosage every few weeks. The amount of the decrease keeps getting smaller. Some people find they can go faster and some people find they have to go slower -- they can only tolerate decreases of a fraction of a milligram at a time. See Why taper by 10% of my dosage?

 

Very careful tapering is necessary when you have had psychotic symptoms. Withdrawal symptoms that look like psychosis can appear even in those who never had psychosis. If you have a prior diagnosis of psychosis, emergence of these symptoms from dopamine supersensitivity can cause you to become diagnosed as "relapsed" and re-medicated. Read Psychiatrist: Some patients are better off without antipsychotics...

from Invega official FDA Information

Quote

INVEGA® Extended-Release Tablets are available in the following strengths and colors: 1.5 mg (orange-brown), 3 mg (white), 6 mg (beige), and 9 mg (pink).

 
Invega is also administered as an injection, Invega Sustenna http://www.drugs.com/pro/invega-sustenna.html:
 

Quote

Recommended initiation of INVEGA® SUSTENNA® is with a dose of 234 mg on treatment day 1 and 156 mg one week later, both administered in the deltoid muscle. The recommended monthly maintenance dose is 117 mg; however, based on previous clinical history of tolerability and/or efficacy, some patients may benefit from lower or higher maintenance doses within the additional available strengths (39 mg, 78 mg, 156 mg, and 234 mg). Following the second dose, monthly maintenance doses can be administered in either the deltoid or gluteal muscle.
 
Adjustment of the maintenance dose may be made monthly. When making dose adjustments, the prolonged-release characteristics of INVEGA® SUSTENNA® should be considered [see Clinical Pharmacology (12.3)], as the full effect of the dose adjustment may not be evident for several months.

 
Tapering off Invega extended-release tablets
The range of dosages available in the tablets suggests one might step down using a combination of tablets. For example, to taper from 12 mg/day, one might get a prescription filled for 9mg and 1.5mg tablets, for a reduction to 10.5mg/day.
 
The extended-release characteristic is in the shell of the tablets.
According to the manufacturer http://www.invega.com/how-to-take-invega-antipsychotic-medications
 

Quote

INVEGA® releases its medicine over a 24-hour period. As the tablet passes through your body, it gives off the medicine at a constant rate.

The medicine in the INVEGA® tablet is contained in a nonabsorbable shell. This shell will leave your body in your stool. If you see the shell, do not worry. This is normal.

 
Conceivably, splitting an Invega tablet would make it immediate-release paliperdone, which may need to be dosed twice a day. Without a shell, the half-life of the basic drug, paliperidone, in Invega appears to be 20-24 hours at a dose of 1mg http://dmd.aspetjournals.org/content/36/4/769/T1.expansion.html
 
See comments from people who have tapered below in this topic. 
 
To taper from small amounts of Invega, one might switch to risperidone liquid.
 
Taper by switching to risperidone liquid
Paliperidone is a close relative of risperidone, being it is an active metabolite of risperidone, according to http://www.drugs.com/pro/risperidone.html

Titrating a liquid is very good for very small measured decreases in dosage, allowing more precise measurements.

from Risperdal Official FDA Information

Quote

Risperdal® Oral Solution can be administered directly from the calibrated pipette, or can be mixed with a beverage prior to administration. Risperdal® Oral Solution is compatible in the following beverages: water, coffee, orange juice, and low-fat milk; it is NOT compatible with either cola or tea.

 
If you want to do this, be sure to read Tips for tapering off Risperdal (risperidone)

 

Injectable Invega Sustenna: Letting it wear off
Invega may be administered via injection every 4 weeks. This form is called Invega Sustenna.

 

Invega Sustenna is intended to last at "therapeutic" strength for a month, then you would get another injection to keep up the potency. Its half-life is very long -- 25 to 49 days. This means that at 25-49 days, it has worn off to half-strength in your body. It would take about 125-343 days for it to completely leave your body.

 

The blood level and side effects will be highest shortly after the injection, then wear off somewhat. Given the very long half-life, if you have gotten a single application of Invega Sustenna (often two injections close together), you must let your body gradually metabolize it to go off it.

 

Switching from injectable Invega Sustenna to tablet form to taper
If you get withdrawal symptoms while letting injectable Invega Sustenna wear off, you may need to taper more slowly. Conceivably, one might switch to a lower dosage in the tablet form about a month after the injection; tablets come in a range of dosages that make tapering easier.
 
See Sec.2.6.1. Table 4 on http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1af14e42-951d-414d-8564-5d5fce138554#section-2.7 for the equivalents of Invega Sustenna (injection) and Invega extended-release tablets. 

 
That page notes

Quote

If INVEGA® SUSTENNA® is discontinued, its prolonged-release characteristics must be considered....

 
If you wish to switch to the tablet form to taper (see below), the following is important http://www.drugs.com/pro/invega-sustenna.html:
 

Quote

Pharmacokinetics

Absorption and Distribution
Due to its extremely low water solubility, paliperidone palmitate dissolves slowly after intramuscular injection before being hydrolyzed to paliperidone and absorbed into the systemic circulation. Following a single intramuscular dose, the plasma concentrations of paliperidone gradually rise to reach maximum plasma concentrations at a median Tmax of 13 days. The release of the drug starts as early as day 1 and lasts for as long as 126 days.
 
....The release profile and dosing regimen of INVEGA® SUSTENNA® results in sustained therapeutic concentrations....
 
Metabolism and Elimination
....The median apparent half-life of paliperidone following INVEGA® SUSTENNA® single-dose administration over the dose range of 39 mg – 234 mg ranged from 25 days – 49 days.

Long-Acting Paliperidone Palmitate Injection versus Oral Extended-Release Paliperidone
INVEGA® SUSTENNA® is designed to deliver paliperidone over a monthly period while extended-release oral paliperidone is administered on a daily basis. The initiation regimen for INVEGA® SUSTENNA® (234 mg/156 mg in the deltoid muscle on Day 1/Day 😎 was designed to rapidly attain steady-state paliperidone concentrations when initiating therapy without the use of oral supplementation.
 
In general, overall initiation plasma levels with INVEGA® SUSTENNA® were within the exposure range observed with 6–12 mg extended-release oral paliperidone. The use of the INVEGA® SUSTENNA® initiation regimen allowed patients to stay in this exposure window of 6–12 mg extended-release oral paliperidone even on trough pre-dose days (Day 8 and Day 36). The intersubject variability for paliperidone pharmacokinetics following delivery from INVEGA® SUSTENNA® was lower relative to the variability determined from extended-release oral paliperidone tablets. Because of the difference in median pharmacokinetic profiles between the two products, caution should be exercised when making a direct comparison of their pharmacokinetic properties.

 

If you are switching from the injection to the extended-release tablets, you need to be careful about the overlap -- you could be taking a high dose if you have recently had an injection and you add tablets. Probably the safest time to make the switch would be at the end of the 4 weeks, when the injection is wearing off.

 

Gradually lowering dosage of injections

If you need to gradually lower the dosage of the injections to taper off, this can be accomplished by systematically reducing the amount of liquid injected. This requires the cooperation of a doctor.
 
This is not easy -- the manufacturer, Janssen, intends the dosage to be delivered all at once and supplies only uncalibrated syringes -- they do not have markings on them to measure the contents. Giving 2 injections of different dosages, for example 156mg and 78mg to add up to 234mg, might cause an increased blood level of Sustenna, above that of a single 234mg shot. From an e-mail from the manufacturer posted on the College of Psychiatric and Neurologic Pharmacists (CPNP) site http://cpnp.org/sites/default/files/shared/2011/pub_email.pdf 
 

Quote

ADMINISTRATION OF 234 MG PALIPERIDONE PALMITATE AS SIMULTANEOUS
156 MG AND 78 MG INJECTION
No systematically collected data is available on using paliperidone palmitate 156 mg plus
paliperidone palmitate 78 mg in place of a paliperidone palmitate 234 mg injection. However,
pharmacokinetic simulations2 show that when paliperidone palmitate 156 mg and paliperidone
palmitate 78 mg are administered as two separate injections on the same day there is an
approximate 15% increase in peak plasma paliperidone concentration and a 9% increase in
trough paliperidone concentration after the first cycle. After two and three cycles of receiving the
156 mg dose and the 78 mg dose as separate injections administered on the same day, patients
will have 11% and 11% higher peak concentrations, respectively, and 8% and 6% higher trough
concentrations, respectively. These simulated increases in plasma paliperidone concentrations
are less than the intra-subject variability seen in clinical trials.

 
If you were getting 234mg injections, it's possible you might get a 156mg plus a 39mg injection to reduce to 195mg, but I couldn't find any information about this. You would definitely need a cooperative prescriber to accomplish tapering an injection.

 

Switching from tablet form to injectable Invega Sustenna to taper

For those considering switching from tablet to injection to taper, as noted above, getting decreasing injection amounts to taper will require the cooperation of a prescriber, which may be hard to find.

 

Before initiating this method, be sure the prescriber agrees the goal is to continually reduce your palperidone dosage, not to maintain you on the injectable indefinitely.

Please be aware, the switch from tablet to injection may be a little bumpy as well, with higher risk of adverse drug effects shortly after it's injected, as this will cause a bump in drug plasma level.

Edited by Altostrata
updated

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 1 year later...
  • Moderator Emeritus

So if this were administered tri-monthly (every third month) 

 

What would serum levels look like?

"Easy, easy - just go easy and you'll finish." - Hawaiian Kapuna

 

Holding is hard work, holding is a blessing. Give your brain time to heal before you try again.

 

My suggestions are not medical advice, you are in charge of your own medical choices.

 

A lifetime of being prescribed antidepressants that caused problems (30 years in total). At age 35 flipped to "bipolar," but was not diagnosed for 5 years. Started my journey in Midwest United States. Crossed the Pacific for love and hope; currently living in Australia.   CT Seroquel 25 mg some time in 2013.   Tapered Reboxetine 4 mg Oct 2013 to Sept 2014 = GONE (3 years on Reboxetine).     Tapered Lithium 900 to 475 MG (alternating with the SNRI) Jan 2014 - Nov 2014, tapered Lithium 475 mg Jan 2015 -  Feb 2016 = GONE (10 years  on Lithium).  Many mistakes in dry cutting dosages were made.


The tedious thread (my intro):  JanCarol ☼ Reboxetine first, then Lithium

The happy thread (my success story):  JanCarol - Undiagnosed  Off all bipolar drugs

My own blog:  https://shamanexplorations.com/shamans-blog/

 

 

I have been psych drug FREE since 1 Feb 2016!

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They'd be bumped up after the injection. The graph would look like an "N", stretched out.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Hey Altostrata, 

 

I have an inquiry. I was misdiagnosed with psychosis and was given Invega Sustenna for 5 months at 78 mg per month. I was wondering, do I need to taper the injection or will I be fine just stopping it? My psychiatrist has told me that a taper is not necessary because a depot injection has a longer half life than the pills, and therefore it tapers itself as it is excreted slowly. He just told me to stop the injections and not to get anymore as I did not need it to begin with. So should I just let the injection wear off? Or should I switch to the oral form of Invega to taper off. I really do not want to take anymore doses of Invega and I think that it is best for me to just stop the injections. What is the likelihood that I will experience withdrawal symptoms? I have read many articles online by doctors who have suggested that tapering off injections is not necessary as they are slowly excreted over a long period of time. What are your thoughts? 

Invega Sustenna 234 mg & 156 mg (January 2016)

Invega Sustenna 78 mg (February to May 2016)

Now off Invega Sustenna since May 30th, 2016

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I'm not Alto but I have been digging into the pharmacokinetics of Invega Sustenna.

 

This is what your pDoc was referring to as slow excretion: In studies, the half-life of Invega Sustenna was 25-49 days. Let's use a number toward the lower end of the range, 30 days as the measure. Here's a table showing what that means [x] days after a dose:

 

+---------+---------------------+

|# days   | % drug still in     |

|         | body unmetabolized  |

+---------+---------------------+

|  30     |     50              |

+---------+---------------------+

|  60     |     25              |

+---------+---------------------+

|  90     |     12.5            |

+---------+---------------------+

| 120     |      6.25           |

+---------+---------------------+

 

As you can see the concentration of the drug drops slowly. Compare that to the worst psych drug -- Effexor with a half-life of 4 HOURS. Sixteen hours after their last dose, a person taking effexor has the same % of the drug as an Invega prescribee has at 120 days after the last Invega Sustenna injection.

 

It's not impossible, just less likely that you'll experience withdrawal symptoms. You might want to ask your pDoc whether s/he's willing to prescribe oral tablets in the event that you do start to experience withdrawal symptoms. You could then stabilize on that and taper.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

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Thank you so much! I really appreciate your reply to my inquiry. I am just waiting to see what Altostrata has to say, but I really appreciate your feedback. I really do hope that I do not get any withdrawal symptoms. I have suffered enough for the past few months. Great to know that it is less likely that I will experience withdrawal symptoms.

Edited by scallywag
deleted quote of long post immediately above

Invega Sustenna 234 mg & 156 mg (January 2016)

Invega Sustenna 78 mg (February to May 2016)

Now off Invega Sustenna since May 30th, 2016

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Theoretically, an Invega injection tapers itself.

 

Thank you, scallywag, for that very informative and graphically astonishing example of ASCII art.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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In addition, an advantage of switching to risperdone from invega (whether tablets or liquid as Alto mentioned - and especially from the depot) is that it seems the risk of akathisia and other EPS issues is less frequent .

 

Personally, since parkinsons runs in my family, even high dose old fashioned first generation anti histamines give me akathisia let alone "standard acting" atypicals like Risperdone , which for me is life threatening, personally .

 

As always, talk things over with a doctor that has your best interest at heart .

My Withdrawal History:

 

Zyprexa 2.5 to 10 mg -July 2014 to December 2015 - Stopped January 2016 .

 

Benzodiazepines (Xanax 1mg, Klonopin 2mg, Restoril 30mg, Halcion 0.5mg):

As needed from Summer 2013 to July 2014 . Used nightly from January 2016 to March 1, 2016. XYREM 9.0g - used last nightly only last two weeks of February

 

Lexapro 5mg from Summer 2016 to January 2016 . Stopped January 2016 . Then caved into the WD insomnia and was on and off Klonopin 2/4mg and Zyprexa 10mg until I built tolerance and cold turkeyed in August 2017.

 

Officially Medication Free Since August 1, 2017 . 

 

Never Suffer Needlessly - it ages you  .  Make the most of what you have been dealt . Be kind to yourself and peacefully reach your goals .

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  • 3 weeks later...
  • Moderator Emeritus

Was just reading about this one in wikipedia:  https://en.wikipedia.org/wiki/Paliperidone

 

I was looking for receptor affinity, which seems mostly D2 and 5HT2a(serotonin) with some H1 (histamine) thrown in for fun.

 

As mentioned here, it is a descendant of risperidal, and has some of the same prolactin effects of that drug. (males growing breasts, for example, and women lactating)

 

What caught my attention was the side effect profile:

 

 

Adverse effect incidences[edit]

Sources:[10][11][12][13]

Very Common (>10% incidence)
  • Headache
  • Tachycardia
  • Somnolence (causes less sedation than most atypical antipsychotics[14])
  • Insomnia
  • Hyperprolactinaemia (seems to cause comparable prolactin elevation to its parent drug, risperidone[14])
Common (1–10% incidence)Deaths[edit]

In April 2014, it was reported that 21 Japanese people who had received shots of the long-acting injectable paliperidone to date had died.[15][16][17][18][19][20][21]

 

and those references 15-21 are here:

 

"Easy, easy - just go easy and you'll finish." - Hawaiian Kapuna

 

Holding is hard work, holding is a blessing. Give your brain time to heal before you try again.

 

My suggestions are not medical advice, you are in charge of your own medical choices.

 

A lifetime of being prescribed antidepressants that caused problems (30 years in total). At age 35 flipped to "bipolar," but was not diagnosed for 5 years. Started my journey in Midwest United States. Crossed the Pacific for love and hope; currently living in Australia.   CT Seroquel 25 mg some time in 2013.   Tapered Reboxetine 4 mg Oct 2013 to Sept 2014 = GONE (3 years on Reboxetine).     Tapered Lithium 900 to 475 MG (alternating with the SNRI) Jan 2014 - Nov 2014, tapered Lithium 475 mg Jan 2015 -  Feb 2016 = GONE (10 years  on Lithium).  Many mistakes in dry cutting dosages were made.


The tedious thread (my intro):  JanCarol ☼ Reboxetine first, then Lithium

The happy thread (my success story):  JanCarol - Undiagnosed  Off all bipolar drugs

My own blog:  https://shamanexplorations.com/shamans-blog/

 

 

I have been psych drug FREE since 1 Feb 2016!

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  • 6 months later...

I have successfully tapered down to 75mg of Invega Sustenna down from 150mg over the span of 8-10 months. Both these reductions were not the easiest since 150 -> 100 is a 50% decrease (didn't know about this forum and 10% rule at the time-- just felt the need to cut down on this **** and insisted on it) then there was no way to taper 10% because of set increments so I took the risk and went down to 75mg (25% decrease) which was also quiet uncomfortable.... to say the least.

 

I have been on 75 for approx 4 months and feel it maybe time to reduce again.

 

Now comes the problem.

 

Next increment is 50mg

 

I am absolutely not going from 75 to 50mg unless im under some intense medical care by a compassionate team.

 

So, the alternative is to find a way to wean off from 75 to the equivalency of 68-69mg. How on earth do i do that.

 

My psychiatrist is suggesting to (blindly) go to 50 mg and add 3mg oral pill daily.

 

I mean, what the hell? how does that even make sense.. That will lead to some unknown quantity in my body as the calculation is not that simple AND she knows that AND she doesnt want to do any work to find out more so we can make more INFORMED, CONSCIOUS decisions.

 

I am so angry.

 

How can she suggest such a thing.. also WITH NO PLAN.. i mean.. so whats next, how do i taper off from that?

 

I really hope somebody here has the/an answer.

 

I will be forever grateful.

 

Seems like the odds are just stacked against us when it comes to needing to get off these drugs.

 

Best 

Taking 1050mg of Lithium, 1500mg of Devalproex Sodium, 75mg of Invega Sustenna injection once a month (This has been weened down twice- once from 150mg to 100mg in February '16 and 100mg to 75mg in August). The reason I ween this down more than 10% at a time is because it comes in an injection form and in set dosages.


I also take Vitamin B, C, Rhodiola, and Omega 3.


 


Check out my YouTube Channel for my rants on weaning off drugs.

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  • 2 weeks later...
  • Administrator

It's true, LuiB, the drugs are not designed for tapering and few physicians have given any thought to it.

 

You are fortunate in finding a doctor who will cooperate with your wish to go off the drugs. Congratulations on reducing your dosage as far as you've done.

 

The first post in this topic gives several suggestions for coming off Invega Sustenna. Please read it carefully and consider the techniques. If you have further questions, please post them in this topic.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 2 weeks later...

How long after taking Invega Sustenna does it take for dopamine to start binding to receptors again? 

 

How long does it take for your brain and body to normalize once stopping the drug?  

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Sorry, I meant to say, "How long after stopping Invega Sustenna does it take for dopamine to start binding to receptors again?" 

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There is some information about when the medication reaches its peak serum concentration.

 

You may wish to read about the pharmacokinetics of Invega Sustenna on drugs.com

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

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  • 3 months later...

I have a friend who did not go in for her invega sustenna injection on May 9. She is not able to become a member and cannot navigate online. She wants some info on switching from Invega sustenna to the long acting tablet form. She has experienced akathisia and insomnia. Her history is: seroquel 50-100 mg early 2015 for approximately 6 mos then risperdal dose unknown for 6 mos then 256 mg Invega sustenna for a year. Then 156 mg in April then nothing but half a mg cogentin since. She seems to have a practioner who may be open to tapering. It's hard to tell. She could not bear the akathisia any longer and was not sleeping. I read the topic through. How can I help her?

I am not a medical professional. My comments and posts are based on personal experiences. Please consult appropriate medical professionals for advice. 

I was started on psych drugs back in the late 80's. You name it. I probably was on it. Tapered off final cocktail 2013-2019. For Hashimotos and high blood pressure I take Levothyroxine. Liothyronine. Spironolactone. Hydrochlorothiazide. Losartan. B12 hydroxy. Fish oil w/D3. Bee pollen. Magnesium Glycinate.

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Marsha, you might print out the first post in this topic for your friend. If her symptoms arose as the Invega injection wore off, "reinstatement" with a low-dose tablet might help.

 

As your friend cannot participate, we can't do much to counsel her, we need to ask lots of questions. It's too difficult when someone is relaying the information.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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I completely understand and agree. I will try to walk her through the registration process. Thanks so much.

I am not a medical professional. My comments and posts are based on personal experiences. Please consult appropriate medical professionals for advice. 

I was started on psych drugs back in the late 80's. You name it. I probably was on it. Tapered off final cocktail 2013-2019. For Hashimotos and high blood pressure I take Levothyroxine. Liothyronine. Spironolactone. Hydrochlorothiazide. Losartan. B12 hydroxy. Fish oil w/D3. Bee pollen. Magnesium Glycinate.

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Please post in this topic if you are tapering Invega -- what techniques are you using?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 1 year later...

I'd read a bit earlier in the thread, that the medication wears itself off naturally after taking the last dose. 

 

Might this still be considered safe to do, even if one's been taking 156 mg of Invega Sustenna for more than a decade? What about in instances, where one is beginning to show mild signs of TD in a few small areas of the body?

 

What might the taper process look like, if one wanted to offset such symptoms or reduce their likelihood of them emerging and remaining permanent?

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  • 5 months later...
  • Moderator

There are 3 month and 6 month shots now.  I do not know enough about getting off this stuff yet.  It might be possible to step down dosages of these longer term shots to some extent.  I might look at compiling some BPL graphs into a "road map" there, at least down to some safe level to transition into titration.

My hunch is though that it would be better to get onto a tablet or liquid form instead.  Too many memories of needing to hold and change dosages during my olanzapine taper.  Also, the lump on my arm that still hasn't gone down from the shot.

I will update this thread when the day comes.

I am not a health professional - your actions are your own.  

Please do not seek tapering support via private message - "Any reason to hold is a good one"

My taper visualised as a graph   |   My intro thread

Backdrop:  2003 10mg olanzapine | 2004 2-3mg risperidone | end 2014 3wks aripiprazole

2015: olanzapine  10 -> 7½ -> 6⅔ -> 5mg  by crude pill cutter

2018:  Mar 5.00mg -> water titrated taper -> Aug2.5mg tablet and hold

Jan 2019 2.50mg water titration -> Jan 2020 1.214  -> Jan 2021 0.44 -> 2 Oct 0.205 ->3 Oct ZERO🥂

Jun 2023 💉150mg paliperidone "loading" depot shot, 100mg 1wk after Jul 100mg Aug-Dec 75mg/4wks

Jul 2023 2.50mg aripiprazole/day attempt to lower prolactin^

Jan-Feb 2024 cross taper off shots to 1mg risperidone

 

Ask not what you can do for your country, but what your country did to you"  -- KMFDM

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  • 1 month later...
  • Moderator
On 1/29/2023 at 4:27 PM, DailyRecovery31 said:

I'd read a bit earlier in the thread, that the medication wears itself off naturally after taking the last dose. 

 

Might this still be considered safe to do, even if one's been taking 156 mg of Invega Sustenna for more than a decade? What about in instances, where one is beginning to show mild signs of TD in a few small areas of the body?

 

What might the taper process look like, if one wanted to offset such symptoms or reduce their likelihood of them emerging and remaining permanent?

 

A member tried this and was re-hospitalised.  It seems it was too fast.  This might work for some people in the longer lasting shots - I don't really know - but I would do everything I can to keep to the 10%/mo or slower of previous dosage plan.  My plan is to supplement with oral dosing until the injection has reasonably been cleared from my body, stepping up a bit after a month and eventually be dealing with a known quantity again, gaining control of the taper that way.

I am not a health professional - your actions are your own.  

Please do not seek tapering support via private message - "Any reason to hold is a good one"

My taper visualised as a graph   |   My intro thread

Backdrop:  2003 10mg olanzapine | 2004 2-3mg risperidone | end 2014 3wks aripiprazole

2015: olanzapine  10 -> 7½ -> 6⅔ -> 5mg  by crude pill cutter

2018:  Mar 5.00mg -> water titrated taper -> Aug2.5mg tablet and hold

Jan 2019 2.50mg water titration -> Jan 2020 1.214  -> Jan 2021 0.44 -> 2 Oct 0.205 ->3 Oct ZERO🥂

Jun 2023 💉150mg paliperidone "loading" depot shot, 100mg 1wk after Jul 100mg Aug-Dec 75mg/4wks

Jul 2023 2.50mg aripiprazole/day attempt to lower prolactin^

Jan-Feb 2024 cross taper off shots to 1mg risperidone

 

Ask not what you can do for your country, but what your country did to you"  -- KMFDM

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36 minutes ago, DailyRecovery31 said:

Hi  hayduke,

 

What do you mean by "stepping up a bit after a month and eventually be dealing with a known quantity again, gaining control of the taper that way?" I'm not exactly sure what you mean by that ...

 

Thanks,

 

DailyRecovery31

 

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  • 1 month later...
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On 8/26/2023 at 12:07 PM, DailyRecovery31 said:

Hi  hayduke,

 

What do you mean by "stepping up a bit after a month and eventually be dealing with a known quantity again, gaining control of the taper that way?" I'm not exactly sure what you mean by that ...

 

Thanks,

 

DailyRecovery31


I mean gradually increasing the amount of oral dosage as the injection wears off, to try and approximate an even blood plasma level of the drug.

I am not a health professional - your actions are your own.  

Please do not seek tapering support via private message - "Any reason to hold is a good one"

My taper visualised as a graph   |   My intro thread

Backdrop:  2003 10mg olanzapine | 2004 2-3mg risperidone | end 2014 3wks aripiprazole

2015: olanzapine  10 -> 7½ -> 6⅔ -> 5mg  by crude pill cutter

2018:  Mar 5.00mg -> water titrated taper -> Aug2.5mg tablet and hold

Jan 2019 2.50mg water titration -> Jan 2020 1.214  -> Jan 2021 0.44 -> 2 Oct 0.205 ->3 Oct ZERO🥂

Jun 2023 💉150mg paliperidone "loading" depot shot, 100mg 1wk after Jul 100mg Aug-Dec 75mg/4wks

Jul 2023 2.50mg aripiprazole/day attempt to lower prolactin^

Jan-Feb 2024 cross taper off shots to 1mg risperidone

 

Ask not what you can do for your country, but what your country did to you"  -- KMFDM

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I was searching for injection BPL/time graphs and came across this handy tool.  Unfortunately the y-axis isn't marked with quantity, but it might still be helpful when bridging from depot shots to oral drug administration.

 

https://www.educationaldoseillustrator.com/pp1m/schizophrenia/scenario/single-dose-curve-view

I whipped some gradations on the graph for the shot I am presently given, for some rough approximation.

 

 

pali bpl.png

Edited by hayduke
Add rendered graph

I am not a health professional - your actions are your own.  

Please do not seek tapering support via private message - "Any reason to hold is a good one"

My taper visualised as a graph   |   My intro thread

Backdrop:  2003 10mg olanzapine | 2004 2-3mg risperidone | end 2014 3wks aripiprazole

2015: olanzapine  10 -> 7½ -> 6⅔ -> 5mg  by crude pill cutter

2018:  Mar 5.00mg -> water titrated taper -> Aug2.5mg tablet and hold

Jan 2019 2.50mg water titration -> Jan 2020 1.214  -> Jan 2021 0.44 -> 2 Oct 0.205 ->3 Oct ZERO🥂

Jun 2023 💉150mg paliperidone "loading" depot shot, 100mg 1wk after Jul 100mg Aug-Dec 75mg/4wks

Jul 2023 2.50mg aripiprazole/day attempt to lower prolactin^

Jan-Feb 2024 cross taper off shots to 1mg risperidone

 

Ask not what you can do for your country, but what your country did to you"  -- KMFDM

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  • 4 weeks later...

It's been a while since I've posted to the forums. But I had a question about tapering off Invega Sustenna vs. the oral tablet.

 

When entering the amount of the liquid injectable into the taper spreadsheet, is it exactly the equivalent to the oral tablet dose?

 

So for instance, I take 156 mg of Invega Sustenna.

 

Is this the equivalent to 9 mg of the oral tablet? Or do I need to taper down from the injectable for roughly 27 months (when I have 9.07 mg of the drug in my system), before I reach the equivalent of having 9.00 mg of the oral tablet in my body?

 

Please let me know,

 

DailyRecovery31

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@DailyRecovery31

 

No, the dosage in the shots is the total for the month (or 3/6 months for the longer acting shots).

 

I have seen a table of dosage equivalents, but cannot find it now.  I did find this snippet on Jansens' web site:

  • Paliperidone (9-hydroxyrisperidone) among adults receiving either orally administered paliperidone ER 6 mg/day or INVEGA SUSTENNA 117 mg/28 days.

which should give a rough indication.  I will post back if I find a better table.

 

The drug company's advice is just to start the full oral dose a month after the last shot.  I would be tempted to try cross tapering rather than just chuck the pills straight on top, but I haven't got to this stage yet.

Edited by hayduke

I am not a health professional - your actions are your own.  

Please do not seek tapering support via private message - "Any reason to hold is a good one"

My taper visualised as a graph   |   My intro thread

Backdrop:  2003 10mg olanzapine | 2004 2-3mg risperidone | end 2014 3wks aripiprazole

2015: olanzapine  10 -> 7½ -> 6⅔ -> 5mg  by crude pill cutter

2018:  Mar 5.00mg -> water titrated taper -> Aug2.5mg tablet and hold

Jan 2019 2.50mg water titration -> Jan 2020 1.214  -> Jan 2021 0.44 -> 2 Oct 0.205 ->3 Oct ZERO🥂

Jun 2023 💉150mg paliperidone "loading" depot shot, 100mg 1wk after Jul 100mg Aug-Dec 75mg/4wks

Jul 2023 2.50mg aripiprazole/day attempt to lower prolactin^

Jan-Feb 2024 cross taper off shots to 1mg risperidone

 

Ask not what you can do for your country, but what your country did to you"  -- KMFDM

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@DailyRecovery31

 

From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175146/

"

Results

Oral risperidone doses of 1, 2, 3, 4, and 6 mg/d are expected to result in similar SS PK as PP1M doses of 25, 50, 75, 100, and 150 mg eq. (which correspond to 39, 78, 117, 156, and 234 mg of paliperidone palmitate) respectively (ie 25‐fold dose conversion factor from oral risperidone to PP1M).

"

 

It's worth noting that the oral paliperidone is "extended release", which would necessitate dosing twice daily once dissolving or breaking apart a tablet.  Seems to me it would make better sense to transition to risperidone if the intent is oral tapering.

I am not a health professional - your actions are your own.  

Please do not seek tapering support via private message - "Any reason to hold is a good one"

My taper visualised as a graph   |   My intro thread

Backdrop:  2003 10mg olanzapine | 2004 2-3mg risperidone | end 2014 3wks aripiprazole

2015: olanzapine  10 -> 7½ -> 6⅔ -> 5mg  by crude pill cutter

2018:  Mar 5.00mg -> water titrated taper -> Aug2.5mg tablet and hold

Jan 2019 2.50mg water titration -> Jan 2020 1.214  -> Jan 2021 0.44 -> 2 Oct 0.205 ->3 Oct ZERO🥂

Jun 2023 💉150mg paliperidone "loading" depot shot, 100mg 1wk after Jul 100mg Aug-Dec 75mg/4wks

Jul 2023 2.50mg aripiprazole/day attempt to lower prolactin^

Jan-Feb 2024 cross taper off shots to 1mg risperidone

 

Ask not what you can do for your country, but what your country did to you"  -- KMFDM

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@guile2 I would think that you are at considerable risk of rehospitalisation unless you go onto a long slow taper of paliperidone or risperidone tablets off the back of your last paliperidone shot, and maybe find some suitable therapy along the way.  I am glad your plant formula makes you feel better, but it's a long road and I don't think the plants will be enough on their own.

Edited by hayduke

I am not a health professional - your actions are your own.  

Please do not seek tapering support via private message - "Any reason to hold is a good one"

My taper visualised as a graph   |   My intro thread

Backdrop:  2003 10mg olanzapine | 2004 2-3mg risperidone | end 2014 3wks aripiprazole

2015: olanzapine  10 -> 7½ -> 6⅔ -> 5mg  by crude pill cutter

2018:  Mar 5.00mg -> water titrated taper -> Aug2.5mg tablet and hold

Jan 2019 2.50mg water titration -> Jan 2020 1.214  -> Jan 2021 0.44 -> 2 Oct 0.205 ->3 Oct ZERO🥂

Jun 2023 💉150mg paliperidone "loading" depot shot, 100mg 1wk after Jul 100mg Aug-Dec 75mg/4wks

Jul 2023 2.50mg aripiprazole/day attempt to lower prolactin^

Jan-Feb 2024 cross taper off shots to 1mg risperidone

 

Ask not what you can do for your country, but what your country did to you"  -- KMFDM

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1 hour ago, hayduke said:

@guile2 I would think that you are at considerable risk of rehospitalisation unless you go onto a long slow taper of paliperidone or risperidone tablets off the back of your last paliperidone shot, and maybe find some suitable therapy along the way.  I am glad your plant formula makes you feel better, but it's a long road and I don't think the plants will be enough on their own.

This may be the case. My point was not that tapering can be replaced but that there are natural things besides tapering that can help. 

 

What im doing is experimental i dont want to get anybody else trying it. Tapering is a tried and true way of getting off drugs safely. 

 

I was simply sharing that if you take care of yourself by getting into nature, organically grown plants spices herbal noncaffeinated teas vegetables fruits ect in my opinion this is just an opinion theres some  benefits.

 

A person with a broken leg should get a caste for a while this is a tried and true way of healing. But if they wash the wound regularly and dont walk on it and put ointment on it they might notice benefits. A person who wears a caste but gets benefits from other things might end up reinjuring the leg if they take it off or other examples. This is totally true. Doing something experimental shouldnt get others to do it. 

 

But if washing a wound helps somebody and you see somebody else expressing a swollen leg theres a tendency to want to share the experience that when washing your leg you found benefits. However if washing a leg is a highly experimental thing its important to be careful sharing how you did it with anyone. 

 

The problem is wisdom on how to approach this.people in western cultures only try drug plants and roots they never experience that theres so much out there that has benefit. Meanwhile eating large amounts of pesticides and chemicals in their food. Its hard to share that if a person spends years and invests time and personal interest and money they might find things that benefit them. But i would start with juicing organic vegetables like carrots and beets. Seeing how the fresh juice effects you and then experimenting with other organic vegetables. Experimenting with eating organic fruits while trying to eat less sugar. 

https://friendsforpeers.angelfire.com/Index.html - my website and discord server

Zyprexa (not sure what mg) But got off after a month of being put on in hospital. early 2007 Respirodol (experienced ackathesia so got off in 4 - 6 months from a 6mg dose) Later 2007 tried Seroquel but got offbecause didn't like it.  Later 2007 tried Abilify but had ackathesia, got off2008 - 2015 Unmedicated but on Serequel 800mg when hospitalized   Later 2015 - Unmedicated but put on Prolixyn when hospitalized (Had very uncomfortable stiffness so got off immediately when out of hospital)2016 Unmedicated but put on Haldol when hospitalized (caused Seizures and stiffness couldn't lay down for 3 days until taken off) Later 2016Tried Zyprexa irregular dosesEarly 2017 Put on Zyprexa 15mg stayed on 15 mg until 2020 January 2020 Zyprexa 15mg didn't seem to be working so increased to Zyprexa 20mgOctober - December 2020 Reduced Zyprexa from 20 mg to 15mg to 10mg to 7.5mg to 5mg to 2.5mg. Hospitalized January 1st 2021March 2021 15mg Zyprexa April 12.5mg Zyprexa  May, June and July 10mg Zyprexa, August 7.5mg Zyprexa, September 1st toOctober 23th 2021 5mg Zyprexa.  October 23rd - December 13th 3.75mg Zyprexa December 13th - January 12th 3.1mg Zyprexa HOSPITALIZED FOR 4.5 MONTHS put on 10mg then 15mg then 20mg of Zyprexa (Givenlong acting injection of Thorazine as well).  May 23rd 2022 Reduced from 20mg to 17.5mg Zyprexa, June 9th 15mg started nighttime. April 2023 taken off Zyprexa cold turkey and put on two monthly injections of Invega Sustena.

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A couple of weeks ago I started shimming the tail end of the paliperidone shot with oral risperidone.  Hopefully this will lead to a steady dosage to taper from down the road a bit.  I'm writing it up in my intro thread.

I am not a health professional - your actions are your own.  

Please do not seek tapering support via private message - "Any reason to hold is a good one"

My taper visualised as a graph   |   My intro thread

Backdrop:  2003 10mg olanzapine | 2004 2-3mg risperidone | end 2014 3wks aripiprazole

2015: olanzapine  10 -> 7½ -> 6⅔ -> 5mg  by crude pill cutter

2018:  Mar 5.00mg -> water titrated taper -> Aug2.5mg tablet and hold

Jan 2019 2.50mg water titration -> Jan 2020 1.214  -> Jan 2021 0.44 -> 2 Oct 0.205 ->3 Oct ZERO🥂

Jun 2023 💉150mg paliperidone "loading" depot shot, 100mg 1wk after Jul 100mg Aug-Dec 75mg/4wks

Jul 2023 2.50mg aripiprazole/day attempt to lower prolactin^

Jan-Feb 2024 cross taper off shots to 1mg risperidone

 

Ask not what you can do for your country, but what your country did to you"  -- KMFDM

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