Invega Sustenna side effects and how to avoid them

Invega Sustenna is a brand-name medication manufactured by Janssen Pharmaceuticals, Inc. It is classed as an atypical antipsychotic drug used to treat schizophrenia or schizoaffective disorder. While Invega Sustenna is generally well tolerated, there are some potential side effects that people should be aware of. The most common side effects of Invega Sustenna include drowsiness, dizziness, and reactions at the injection site. Less common, but more serious side effects, can include severe allergic reactions, high blood sugar, and weight gain.

Learn more about the side effects of Invega Sustenna and what you can do to avoid them.

What is Invega Sustenna (paliperidone palmitate)?

Invega Sustenna is a brand-name medication manufactured by Janssen Pharmaceuticals, Inc. It is classed as an atypical antipsychotic for the treatment of schizophrenia or schizoaffective disorder. The active ingredient in Invega Sustenna is called paliperidone, which can reduce the symptoms of psychotic episodes caused by schizophrenia or bipolar disorder.

When Invega Sustenna is injected, it is absorbed into your blood and transported to your brain. It then binds with areas on the outside of your brain cells called dopamine and serotonin receptors. Dopamine and serotonin are chemicals that influence and regulate your brain activity, including your experience of pleasure, motivation, reward pathways, thinking, memory, and mood.

By binding with your dopamine and serotonin receptors, paliperidone reduces the effect of dopamine and serotonin on your brain. This has been shown to ease the symptoms of schizophrenia and schizoaffective disorder and to help stop periods of psychosis and mood change from happening.

Invega Sustenna dosage

Invega Sustenna is a long-acting injection. Whereas many antipsychotic medications are taken as a daily pill, Invega Sustenna is given to you as an intramuscular injection (into the deltoid muscle of the arm or the gluteal muscle of the buttocks) by a healthcare professional, usually once a month. Invega Sustenna is released into your system over the course of a month. It may be more suitable for you than a daily oral medication if you struggle to take your medication consistently. Your healthcare provider will decide what dose of Invega Sustenna you will need based on your condition and medical history.

Invega is available as extended-release tablets. Invega Trinza and Invega Hafyera may be used if you have been treated with Invega Sustenna for at least 4 months. Invega Hafyera may also be used if you have been treated with Invega Trinza for at least 3 months. You will need to receive a second dose of Invega Sustenna 1 week after your first dose. After that, you will only need to get a dose once monthly. Invega Trinza will be given to you once every 3 months and Invega Hafyera once every 6 months.

If you miss a dose of Invega Sustenna call your doctor for instructions. You are advised to read the full prescribing information and to always speak with your healthcare provider about any changes to your dose so they can monitor and evaluate your condition.

How effective is Invega Sustenna?

A study called the PRIDE study has shown that long-acting Invega Sustenna (paliperidone palmitate) is effective six months longer than oral antipsychotics in patients with schizophrenia, delaying relapses such as hospitalization, arrest, and incarceration.

Invega Sustenna side effects

The most common possible side effects of Invega Sustenna include:

  • Reactions at the site of injection, including itching, bruising, and pain
  • Drowsiness, sleepiness
  • Lightheadedness, dizziness
  • Restlessness
  • Gastrointestinal disorders such as constipation, dry mouth, dyspepsia, flatulence, salivary hypersecretion
  • Unusual muscle movements and tremors
  • Abnormal movements of your eyes

Invega Sustenna can cause more serious side effects, including:

  • Severe allergic reactions to the medication causing heart palpitations, sweating, fever, skin rashes, and hives, as well as swelling of the face, mouth, and throat that can make it difficult to breathe
  • A rare but potentially fatal condition called neuroleptic malignant syndrome (NMS) caused by an unusual response to antipsychotic medications
  • Irregular heartbeat, including palpitations, skipped beats, and slowing down or speeding up of your heart rate, can cause problems with your heart or make existing heart conditions worse, like heart failure
  • Extrapyramidal symptoms – uncontrolled movements of your tongue, face, mouth, or jaw (tardive dyskinesia)
  • Muscle stiffness, muscle spasms, pain, tenderness, or weakness
  • High blood sugar (diabetes)
  • Weight gain and a rise in your blood cholesterol (or triglyceride) levels
  • Orthostatic hypotension (low blood pressure that can cause fainting)
  • Seizures
  • Problems thinking clearly
  • Problems regulating your body temperature can make you overheat and become dehydrated
  • Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors
  • Difficulty swallowing can cause food or liquid to get into your lungs
  • A long-lasting erection (priapism) in men can lead to permanent damage to the penis
  • Hyperprolactinemia (high prolactin levels in the blood)

If you experience any of these serious side effects, stop taking Invega Sustenna and seek medical attention immediately. You are encouraged to report the negative side effects of prescription drugs to the FDA. Visit, or call 1-800-FDA-1088.

Invega Sustenna drug interactions

Invega Sustenna can interact with other medications including:

  • Any antidepressant medications
  • Any nitrate medications, usually taken to treat chest pain (angina)
  • Any medications you take to treat high blood pressure, like diuretics, alpha-blockers, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, or calcium channel blockers
  • Any antiviral medications taken to treat an HIV infection, including saquinavir
  • Any antibiotics taken to treat a bacterial infection, including rifampicin, clarithromycin, or telithromycin
  • Any antifungal medications taken to treat a fungal infection, including ketoconazole
  • Any anticonvulsant medications taken to reduce the chances of you having seizures, like carbamazepine, phenobarbital, or phenytoin
  • QT-prolongation medications, such as amiodarone, clarithromycin, domperidone
  • St John’s-wort

Before taking Invega Sustenna, be sure to tell your doctor about all of the medications you are taking to ensure they are safe to take at the same time.

Invega Sustenna warnings & precautions

Don’t take Invega Sustenna if:

  • Are allergic to the active ingredient paliperidone, or risperidone
  • Are allergic to any of the other ingredients in Invega Sustenna
  • Are over 65 and have dementia-related psychosis
  • Are under 18 years of age

Talk to your doctor before taking Invega Sustenna if you:

  • Are taking any of the medications that could interact with Invega Sustenna
  • Have ever had any heart problems like heart disease, a heart attack, arrhythmias, or an abnormal heart rhythm
  • Have ever had neuroleptic malignant syndrome
  • Have ever experienced movement disorder of the face and tongue (tardive dyskinesia)
  • Have ever had low levels of white blood cells
  • Have ever had low levels of potassium or magnesium in your blood
  • Have kidney problems
  • Have liver problems
  • Parkinson’s disease
  • Are diabetic or are at risk of diabetes
  • Have ever had priapism (a prolonged and painful erection)
  • Have difficulty controlling your core body temperature, or are prone to overheating
  • Have a high level of the hormone prolactin in your blood or have a prolactin-dependent tumor
  • Are pregnant or are planning to become pregnant
  • Are breastfeeding or are planning to breastfeed

You should always check with your doctor or pharmacist before taking any medication, including Invega Sustenna, to make sure it is safe for you.

Other warnings you should know about

  • Invega Sustenna can cause side effects like drowsiness, and dizziness that can impair your ability to operate machinery, drive, or perform other dangerous tasks. Avoid these activities when treated with Invega Sustenna until you are sure it does not affect your ability to do them safely
  • Invega Sustenna is not approved for the treatment of dementia-related psychosis. Elderly patients who have dementia-related psychosis are at an increased risk of death
  • It is not known if Invega is safe to use while breastfeeding. The drug can pass into breast milk, and may have undesirable side effects

How to avoid Invega Sustenna side effects

The best way to avoid side effects is to take Invega Sustenna as directed by your doctor. Follow your doctor’s instructions carefully and do not take more or less than prescribed.

If you experience any side effects, talk to your doctor or pharmacist. They may be able to recommend ways to help reduce or prevent some of the side effects.

1. Stick to the recommended dosage

Take your prescribed dose of Invega Sustenna that has been recommended by your healthcare professional. Do not use more or less than specified.

2. Monitor your blood sugar levels

If you have diabetes, it is important to monitor your blood sugar levels closely while using Invega Sustenna. Check your blood sugar levels as directed by your doctor and report any changes to your doctor immediately.

3. Avoid alcohol

Avoid drinking alcohol while taking Invega Sustenna as it can increase your risk of side effects like dizziness, drowsiness, and trouble concentrating. This may affect your ability to think clearly.

4. Know the signs and symptoms of Invega Sustenna’s side effects

Signs and symptoms of side effects include drowsiness, sleepiness, feeling light-headed, dizziness, or unusual muscle movements. Speak to your doctor if you experience any of these side effects.

5. Monitor your weight

Invega Sustenna may cause weight gain. If you experience this side effect while taking Invega Sustenna, get medical advice from your doctor.

6. Tell your doctor about all medications you’re taking

Be sure to tell your doctor about all other medications you’re taking, including over-the-counter drugs, vitamins, and herbal supplements, as they can interact with Invega Sustenna.

7. Get regular medical checkups

It is important to get regular medical checkups and monitor your medical conditions. Your doctor will monitor your progress and may adjust your dose of as needed.

Medically reviewed

A medical professional has reviewed this article.

Jamie Winn, PharmD
Jamie Winn, PharmD

Jamie Winn, PharmD

Medical Writer & Reviewer

Jamie Winn, PharmD

Medical Writer & Reviewer

Dr. Jamie Winn received his Doctor of Pharmacy in 2002 from the University of South Carolina College of Pharmacy, Columbia, SC. Jamie is a medical reviewer for NiceRx.

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The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.