Invega Trinza® (paliperidone palmitate) was added to the Pharmaceutical Benefits Scheme (PBS) on the 1st April 2017. Paliperidone, the major active metabolite of risperidone, is an atypical antipsychotic indicated for the treatment of schizophrenia.

Paliperidone is thought to exert its therapeutic effects through antagonism of central dopamine D2 receptors and serotonin type 2 (5HT2A) receptors. Additional antagonist activity at histamine H1 receptors and α-adrenoceptors contributes to its side effect profile. Adverse effects include hyperprolactinaemia, weight gain, orthostatic hypotension, and sedation. Extrapyramidal effects are minimal at low doses.

Invega Trinza® utilises the palmitate ester of paliperidone which has extremely low water solubility. Following intramuscular injection, paliperidone palmitate slowly dissolves before it is hydrolysed to paliperidone and absorbed into the systemic circulation. This extended apparent half-life allows Invega Trinza® to be administered every three months. Patients who may benefit from this include those with known poor compliance, lack of insight into their condition, and risk of significant consequences in the event of a relapse.

Other paliperidone formulations available on the PBS are shown in Table 1. Invega Trinza® may be considered for patients who have been adequately treated with Invega Sustenna® for at least four months.

Table 1. A comparison of paliperidone formulations available

Invega®

Invega Sustenna®

Invega Trinza®

Form

Modified-release tablet

Modified-release injection

Modified-release injection

Active ingredient

Paliperidone

Paliperidone palmitate

Paliperidone palmitate

Strengths

3mg, 6mg, 9mg

25mg, 50mg, 75mg, 100mg, 150mg

175mg, 263mg, 350mg, 525mg

Indications

Acute and maintenance treatment of schizophrenia.

Acute exacerbations of schizoaffective disorder.

Acute and maintenance treatment of schizophrenia

Maintenance treatment of schizophrenia

Usual dosing frequency

Daily

Monthly

3 monthly

Administration instructions

Swallow tablets whole. Standardise administration with respect to food.

Deep intramuscular injection into deltoid or gluteal muscles

Deep intramuscular injection into deltoid or gluteal muscles

 

References:

  1. Berwaerts J, Liu Y, Gopal S, Nuamah I, Xu H, Savitz A, et al. Efficacy and safety of the 3-month formulation of paliperidone palmitate vs placebo for relapse prevention of schizophrenia. A randomized clinical trial. JAMA Psychiatry. 2015; 72(8): 830-9.
  2. Invega Trinza® (paliperidone palmitate) Australian approved product information. Macquarie Park: Janssen-Cilag. Approved January 2017.

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