Indications for INVEGA:
Schizophrenia in adults and adolescents 12–17yrs of age. Schizoaffective disorder in adults, as monotherapy or as an adjunct to mood stabilizer and/or antidepressants.
Swallow whole. ≥18yrs: 6mg once daily in AM; may increase in increments of 3mg/day at intervals of >4 days (for schizoaffective disorder) or >5 days (for schizophrenia) if needed. Usual range: 3–12mg/day. Max 12mg/day. Renal impairment: CrCl ≥50–<80mL/min: initially 3mg daily, max 6mg/day; CrCl ≥10–<50mL/min: initially 1.5mg daily, max 3mg/day; CrCl <10mL/min: not recommended.
Swallow whole. Schizoaffective disorder: <18yrs: not studied. Schizophrenia: <12yrs: not established. 12–17yrs: initially 3mg once daily in AM; may increase in increments of 3mg/day at intervals of >5 days if needed. Higher doses of 6mg/day (<51kg) and 12mg/day (≥51kg) may not be beneficial.
Increased mortality in elderly patients with dementia-related psychosis.
Elderly with dementia-related psychosis (not approved use): increased risk of death. Discontinue immediately if neuroleptic malignant syndrome (NMS) is suspected. Avoid in congenital long QT syndrome, history of cardiac arrhythmias. Consider discontinuation if tardive dyskinesia occurs. Cardio- or cerebrovascular disease; risks may be increased due to metabolic changes (eg, hyperglycemia, dyslipidemia, weight gain); monitor. Conditions that predispose to hypotension (eg, dehydration, hypovolemia). Diabetes risk factors (obtain baseline fasting blood sugar and periodically thereafter). Perform fall risk assessments when initiating and recurrently on long-term therapy (esp. in elderly). Risk for GI obstruction. Preexisting severe GI narrowing: not recommended. History of significant low WBC/ANC or drug-induced leukopenia/neutropenia; obtain CBCs frequently during 1st few months of treatment; consider discontinuation if significant decline in WBC. Monitor for signs/symptoms of infection in those with neutropenia; discontinue if severe (ANC <1000mm3) and follow WBC until recovery. History of seizures. Conditions that lower the seizure threshold. Patients at risk for aspiration pneumonia. Exposure to extreme temperatures. Write ℞ for smallest practical amount. Reevaluate periodically. Parkinson's disease. Dementia with Lewy bodies. Renal impairment. Severe hepatic impairment. Neonates: risk of extrapyramidal and/or withdrawal symptoms post delivery (due to exposure during 3rd-trimester pregnancy). Pregnancy. Nursing mothers: monitor infants.
Avoid drugs that prolong QT interval (eg, Class 1A and Class III antiarrhythmics, chlorpromazine, thioridazine, gatifloxacin, moxifloxacin). Caution with other CNS drugs, alcohol, drugs that may cause orthostatic hypotension. Caution with anticholinergic drugs that may elevate body temperature. May be potentiated by divalproex sodium; consider dose reduction. May be antagonized by carbamazepine; adjust dose. May antagonize levodopa, other dopamine agonists. Additive effects with concomitant risperidone; caution.
Extrapyramidal symptoms, akathisia, somnolence, tremor, dystonia, cogwheel rigidity, anxiety, weight gain, tachycardia, dyspepsia, constipation, nasopharyngitis; may cause NMS, tardive dyskinesia, QT prolongation, hyperglycemia, dyslipidemia, hyperprolactinemia, orthostatic hypotension, syncope, agranulocytosis, priapism.
Generic Drug Availability: