- ON THIS PAGE:
- Missed Doses
- Dose Adjustments and Special Populations
Missed doses
If a second initiation dose is missed1
LESS THAN 4 WEEKS SINCE FIRST INJECTION
Administer the second initiation dose
of 156 mg in the deltoid muscle as
soon as possible.
- 1Administer a third injection of
117 mg in either the deltoid or gluteal muscle 5 weeks after the first injection (regardless of timing of the second injection) - 2Resume regular monthly dosing in either the deltoid or gluteal muscle
4 TO 7 WEEKS SINCE FIRST
INJECTION
Resume dosing with 2 injections of 156 mg:
- 1Deltoid injection as soon as possible
- 2Deltoid injection 1 week later
- 3Regular monthly dosing in either the deltoid or gluteal muscle
MORE THAN 7 WEEKS SINCE FIRST INJECTION
Restart dosing with normal initiation plan:
- 1234 mg deltoid injection on Day 1
- 2156 mg deltoid injection 1 week later*
- 3Resume regular monthly dosing in either the deltoid or gluteal muscle
*Second initiation dose may be given within a ±4-day flexible dosing window. The utilization of this practice should be considered the exception rather than the rule.1
If a monthly maintenance dose is missed1
4 TO 6 WEEKS SINCE LAST
INJECTION
Resume regular dosing as soon as possible at patient’s previously stabilized dose, followed by injections at monthly intervals.
MORE THAN 6 WEEKS TO 6 MONTHS SINCE LAST INJECTION
Continue dosing at patient’s previously stabilized dose* by giving:
- 1Deltoid injection as soon as possible
- 2Second deltoid injection 1 week later at same dose
- 3Resume monthly deltoid or gluteal injections at patient’s previously stabilized dose 1 month after second dose
*If the patient was stabilized on 234 mg, the first 2 doses should be 156 mg.
MORE THAN 6 MONTHS SINCE LAST INJECTION
Restart dosing with normal initiation plan:
- 1234 mg deltoid injection on Day 1
- 2156 mg deltoid injection 1 week later
- 3Resume regular monthly dosing in either the deltoid or gluteal muscle
To help avoid a missed monthly maintenance dose, patients may be given their monthly maintenance dose within a ±7-day flexible dosing window.1 The utilization of this practice should be considered the exception rather than the rule.
Missing doses should be avoided.1
A few simple adjustments in communication and integration between treatment teams may also help your patients make a successful transition between care settings.
Download these actionable best practices to address 7 common challenges associated with the continuity of care.
Dose adjustments and special populations1
Patients with renal impairment
- INVEGA SUSTENNA® has not been systematically studied in patients with renal impairment1
The dose of INVEGA SUSTENNA® should be reduced in patients with mild renal impairment (creatinine clearance ≥50 mL/min to <80 mL/min)1*
- Recommended initiation dose of INVEGA SUSTENNA® is 156 mg on Day 1 and 117 mg 1 week later, both administered in the deltoid muscle
- Adjust monthly maintenance dose based on tolerability and/or efficacy within the strengths of 39 mg, 78 mg, 117 mg, or 156 mg
- The maximum monthly dose is 156 mg for patients with mild renal impairment
- INVEGA SUSTENNA® is not recommended in patients with moderate or severe renal impairment (creatinine clearance <50 mL/min)1*
*Cockcroft-Gault formula.
Coadministration with strong
inducers of both CYP3A4 and
P-glycoprotein (P-gp)1
- Avoid using a strong inducer of CYP3A4 and/or P-gp (eg, carbamazepine, rifampin, St John’s wort) during the 1-month dosing interval for INVEGA SUSTENNA®, if possible. If administering a strong inducer is necessary, consider managing patient using paliperidone extended-release tablets1
Patients who are pregnant or nursing
- Adequate and well-controlled studies with INVEGA SUSTENNA® have not been conducted in pregnant women. Neonates exposed to antipsychotic drugs during the third trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery1
- INVEGA SUSTENNA® should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus1
- If you become pregnant while taking INVEGA SUSTENNA®, talk to your healthcare provider about registering with the National Pregnancy Registry for Atypical Antipsychotics. You can register by calling 1-866-961-2388 or visit http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/
CYP3A4=cytochrome P450 3A4.
Reference: 1. INVEGA SUSTENNA® [Prescribing Information]. Titusville, NJ: Janssen Pharmaceuticals, Inc.