Some information presented within this Center of Excellence was created in collaboration with the California Department of State Hospitals (DSH). This includes that the content has been specifically aligned to the DSH’s medication guidelines (DSH Psychotropic Medication Operational Procedures, appended to DSH Policy Directive 3400). These medication guidelines are applicable only to the DSH settings and inclusion within this resource does not indicate that they must be followed in any non-DSH settings. The medication guidelines included in this resource are those of DSH and do not necessarily represent the views, policy(ies), and/or position(s) of the American Psychiatric Association (APA).
Invega Trinza | |
Indication(s) | Schizophrenia |
Dosing available as prefilled syringes | 273 mg (injection volume of 0.875 ml) |
Recommended starting and maintenance dose | Used only after establishment of 17 weeks of paliperidone palmitate once every 4 weeks injection (last 8 weeks with the same dose); dose based on paliperidone palmitate IM once every 4 weeks dose |
Drug Metabolizing Enzyme | CYP3A4 |
Dosing exclusions | Invega Trinza is not recommended in patients with moderate or severe renal impairment |
Loading dose | Dose equivalence to paliperidone palmitate once every 4 weeks: 39 mg Invega paliperidone palmitate once every 4 weeks to N/A for Trinza 78 mg of Invega paliperidone palmitate once every 4 weeks to 273 mg for Trinza 117 mg Invega paliperidone palmitate once every 4 weeks to 410 mg Trinza 156 mg paliperidone palmitate once every 4 weeks to 546 mg Trinza 234 mg paliperidone palmitate once every 4 weeks to 819 Trinza |
Oral overlap | None required. |
Establishing tolerability | Prior to initiating Invega Trinza, treat the patient with 4 week formulation of paliperidone palmitate for at least 17 weeks to ensure optimal dosing. To establish a consistent maintenance dose, it is recommended that the last two doses of paliperidone palmitate once every 4 weeks be the same dosage strength before starting Invega Trinza. |
Storage | Room temperature |
Reconstitution or mixing | No reconstitution required. |
Injection site | Choose between the deltoid or gluteal muscle based on the patient preference and body habitus. Rotate injection sites to avoid muscle hypertrophy, abscesses, and tissue damage by repeated frequent injections at the same site. |
Injection interval | Every 12 weeks |
Preparation | With the syringe tip pointing up, shake vigorously with a loose wrist for at least 15 seconds to ensure a homogeneous suspension. If more than 5 minutes pass before injection, shake vigorously, with the syringe tip pointing up, again for at least 15 seconds to re-suspend the medication. Priming the syringe is recommended. |
Administration considerations | Inject the entire contents intramuscularly slowly, deep into the selected deltoid or gluteal muscle of the patient. |
Timing variations | To avoid a missing dose: patients may be given the injection up to 2 weeks before or after the 13 week time point. |
When a dose is missed | If a patient has missed a dose and it is 15 weeks to 17 weeks since the last injection: the previously administered Trinza dose should be administered as soon as possible, then continue with the 13 week injections following the dose. If 17 weeks to 39 weeks since last injection: This requires re-initiation via table 2 in the package insert. |
REMS | No |
Dose Conversion of Oral Paliperidone to Paliperidone Palmitate 12-week LAI | ||
Oral Dose | LAI/Paliperidone Palmitate Once Monthly Dose **Stabilization with Paliperidone Palmitate Once Monthly required prior to initiation of Invega Trinza | LAI/Invega Trinza Dose |
Paliperidone < 3 mg | Paliperidone Palmitate 39 mg once monthly every 4 weeks | N/A |
Paliperidone 3 mg | Paliperidone Palmitate 78 mg once monthly every 4 weeks | Invega Trinza 273 mg every 12 weeks |
Paliperidone 6 mg | Paliperidone Palmitate 117 mg once monthly every 4 weeks | Invega Trinza 410 mg Invega Trinza every 12 weeks |
Paliperidone 9 mg | Paliperidone Palmitate 156 mg once monthly every 4 weeks | Invega Trinza 546 mg Invega Trinza every 12 weeks |
Paliperidone 12 mg | Paliperidone Palmitate 234 mg once monthly every 4 weeks | Invega Trinza 819 mg Invega Trinza every 12 weeks |
Recommended available dose formulations include 273 mg, 410 mg, 546 mg, and 819 mg pre-filled syringes. Dose reduction may be necessary for CYP450 interactions or side effect intolerance. References: 1. Stahl, S. M. (2017). The prescriber’s guide: Stahl’s essential psychopharmacology (6th ed.). New York: Cambridge University Press. 2. American Psychiatric Association. (2020). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890424841 3. INVEGA SUSTENNA USPI, Section 2.8: Instructions for Use; Section 17: How Supplied/Storage and Handling 4. Erzofri USPI, Section 2.7: Preparation and Administration Instructions; Section 16: How Supplied/Storage and Handling 5. California Department of State Hospitals Psychotropic Medication Operational Procedures. (2025). Chapter 20. | ||
FDA Medication Label
Information on this topic is found in the FDA medication label. Not all information in the FDA medication label is included here, and clinicians should read the entire FDA medication label before making treatment decisions.
Prescribing should always be informed by the FDA medication label. Medication labels can be found by searching Drugs@FDA at the FDA website. Labels are also available using the Drugs@FDA app for Apple or Android devices.
Labels change over time, and the current label should always be consulted. Here is the most recent label, at time of writing.
Administration/Dosing Guide
More information about administration (including a detailed video) and dosing can be found here.