Invega (Paliperidone) is an atypical antipsychotic approved in 2006 for the treatment of schizophrenia.  Several years later in 2009, a longer-acting format of the medication called “Invega Sustenna” was also approved.  Invega Sustenna is an injectable form of the drug that is administered every 4 weeks and is thought to be advantageous it mitigates risk of users forgetting to take a daily pill.

The drug functions primarily as a D2 dopamine receptor and 5-HT2A serotonin receptor antagonist.  It also affects the H1 histamine receptor which can promote drowsiness, and also has a modest affinity for the Alpha-1 and Alpha-2 noradrenergic receptors.  Most experts consider Invega a new and improved version of the drug Risperdal due to the fact that it contains the same active metabolite and has less side effects.

Since Invega has a high affinity for the D2 receptor as an antagonist, it is thought to work extremely well for reducing positive symptoms of schizophrenia such as hearing voices (hallucinations) and delusions.  However, many people taking Invega may find that it doesn’t work well enough for negative symptoms and cognitive symptoms of schizophrenia.  Among those that find the drug ineffective or intolerable, withdrawal from the medication may be an appealing option.

Factors that influence Invega withdrawal

Assuming you end up discontinuing Invega, you may experience an array of withdrawal symptoms.  There are generally some common factors responsible for influencing both the number and severity of symptoms you experience.  In addition, these factors tend to predict how quickly you will fully recover following complete cessation of the medication.

  1. Time Span

The duration over which you’ve been taking Invega (or Invega Sustenna) will likely influence the severity of your withdrawal symptoms.  Those that have been taking the drug for a longer duration tend to have a much tougher time coping with discontinuation than those only taking it for a short duration.  In other words, someone that was only on Invega for a few months should have an easier time with the withdrawal than someone taking it for several years.

This is due to the fact that shorter-term administration results in fewer neurophysiological changes to accommodate the drug.  Those that have been taking the drug over a long-term have likely experienced more neurophysiological (neurotransmission, hormone, metabolic, etc.) changes as a reaction to the drug.  As a result, discontinuing after a prolonged duration of usage (e.g. years) will be of greater difficulty for most.

  1. Dosage + Type

It is important to consider the fact that those taking higher doses are likely going to have a much tougher time facing withdrawal than those taking lower doses.  Individuals that ingest high doses of Invega are allowing the drug to have greater influence over their neurochemistry and physiology.  In general, the higher the dose, the greater the shift away from homeostatic functioning and the increase in neurophysiological adaptations stemming from greater potency.

Due to the fact that high doses often are more difficult to discontinue, it is always recommended to take the minimal effective dose.  In other words, taking the minimal amount of the drug for symptomatic management is advised.  In addition to dosage influencing withdrawal, it is important to consider the specific type of Invega you’re taking: extended release vs. injectable.

  • Invega: This is a form of Invega that is manufactured in extended-release tablets that are administered once per day. These tablets are manufactured in doses of 1.5 mg, 3 mg, 6 mg, and 9 mg.  Those that are taking this form of Invega may have an easier time with discontinuation than those attempting to wean off of the injectable form.
  • Invega Sustenna: This format of Invega is injectable, and is usually administered with a starting injection of 234 mg. However, dosages are said to include: 39 mg, 78 mg, 156 mg, and 234 mg.  Due to the larger gaps between doses and tapering difficulty of injections, some people may have a tougher time tapering off of Invega Sustenna.

You may want to work with your doctor to determine whether it would be smart to switch from the Invega Sustenna to the standard Invega tablets for tapering.  The standard extended-release tablets can be tapered by 1.5 mg at a flexible pace.

  1. Cold Turkey vs. Tapering

Quitting Invega cold turkey is likely to be a recipe for withdrawal disaster.  Those who quit cold turkey are essentially stripping their brains of a substance that it was expecting.  If the person was well-adjusted to a high dose and had been taking the drug for a long duration, cold turkey may leave a person’s neurotransmission and nervous system in a state of chaotic disarray.

Those who conduct a slow taper off of Invega are likely to have the best outcomes.  Slow tapering (at an approximate rate of 10% per month) allows the nervous system to gradually adjust to function with less of the drug.  In essence, a slow taper guides your nervous system in the direction of reverting back to homeostasis and simultaneously minimizes severity of withdrawal.

  1. Individuality

It is important to consider that two people could take Invega for the same condition, at the same dose, for the same amount of time, and conduct the exact same tapering schedule – yet have radically different withdrawal symptoms.  Various individual factors will certainly play a crucial role in determining how quickly you recover from withdrawal.  These factors include things like: genetics, daily habits, and whether you use other substances (e.g. medications, supplements, etc.).

For example, someone who has genetics that promote quicker rebalancing of neurochemistry following Invega withdrawal may only have symptoms spanning over the course of a couple weeks.  Another individual may find that their neurochemistry takes much longer to rebalance after Invega discontinuation.  While there isn’t anything you can do to change your genetics, lifestyle choices also matter.

Someone who keeps themselves busy, maintains a sleep schedule, proactively reduces stress, eats a healthy diet, and socializes – may have a better outcome than someone doing the opposite.  Make sure you’re doing everything in your power to maintain a healthy lifestyle, while staying occupied (with work and extracurricular activities) to keep your mind from ruminating upon withdrawal symptoms.

Invega Withdrawal Symptoms: List of Possibilities

Below is a list of symptoms that you may experience upon withdrawing from Invega.  Understand that most people will not experience every last symptom, this is just a list of what users have reported following cessation of Invega.  Realize that the severity of the symptoms is subject to significant individual variation.

  • Agitation: It is common to feel agitated after you’ve discontinued Invega. The agitation may feel like overwhelming nervousness and/or internal excitation.  Some people become irritable and/or restless due to the fact that they feel agitated.  To cope with the agitation, you may want to consider exercise, relaxation, and/or other pharmacological interventions.
  • Anger: Some people will feel incredibly angry and upset as a result of the withdrawal symptoms. Many people are extremely sensitive to negative emotions as they discontinue antipsychotics like Invega.  Do your best to deal with the anger constructively rather than going into a state of rage and/or taking it out on someone else.  Express the anger in the form of art, writing, or go for a run and use some of the extra energy.
  • Anxiety: This medication often decreases arousal and ultimately anxiety for users. However, those who quit taking it may experience a dramatic increase in anxiety.  Even those who never dealt with anxiety prior to using Invega may find themselves unable to stay calm.  Although your nerves may feel a bit “rattled” and hypersensitive, you can take steps to keep your stress level down to cope with anxious thoughts.
  • Appetite changes: Many people notice that their appetite decreases during the withdrawal process. This decrease in appetite may be related to hormone changes and/or as a result of the flu-like symptoms associated with withdrawal.  It’s tough to maintain an appetite when you feel nauseous, dizzy, and as if you’re sick.
  • Concentration problems: Another reported withdrawal symptom is difficulty concentrating. You may have a tough time focusing at school or work – especially during the early stages of withdrawal.  It may seem as though you have severe “brain fog” or clouded thinking and as if your cognitive function is slower than usual.  Understand that your pre-drug level of cognitive function will eventually return.
  • Confusion: Some people may feel exceptionally confused when they first stop taking Invega. The confusion is generally a result of impaired cognitive function, memory problems, and clouded thinking.  This may be caused by fluctuations in levels of neurotransmitters and receptors following cessation of Invega.
  • Crying spells: The depression following Invega withdrawal is significant enough to cause crying spells. You may be unable to hold back tears and may need to release emotions.  While crying is a sign of painful emotion, it can also be a useful coping mechanism.  Realize that as your brain readjusts to functioning without Invega, the withdrawal-induced crying will eventually subside.
  • Depersonalization: While depersonalization could be a symptom of an underlying psychiatric condition, it can also stem from medication withdrawal. Discontinuing Invega may leave your brain trying to fill certain gaps in neurotransmission of dopamine and serotonin that had previously been filled by the drug.  During the process, the assault on your neurotransmitters may result in feeling depersonalized or unlike your homeostatic self.
  • Depression: In certain situations, withdrawal from Invega can result in severe increases in feelings of depression. Even if you were not depressed prior to taking the drug, withdrawal can lead to deep feelings of sadness.  The sadness may be a result of imbalanced neurotransmitters, receptors, and brain activation.  It is recommended to work with a professional to manage these feelings, especially if they are overwhelming.
  • Diarrhea: Some people may endure gastrointestinal distress when they stop taking Invega. They may have an upset stomach and diarrhea.  If your bowel movements are out of control when you cease usage of Invega, you may want to consider conducting a more gradual taper and/or taking some over-the-counter Imodium.
  • Dizziness: It is very common to feel incredibly dizzy when discontinuing Invega, especially if you do it cold turkey. The more rapidly you taper, the more greater the intensity the dizziness is likely to be.  Dizziness can often be minimized with a slower taper, but generally occurs for a couple weeks after the final dose.
  • Fatigue: If you find it difficult to get out of bed in the morning, have low energy throughout the day, and just want to sleep – it could be related to withdrawal. Obviously it could also be related to a resurgence of negative symptoms (e.g. avolition and anhedonia), but the fatigue may be exacerbated by withdrawal.  In some cases it can take an extended duration before homeostatic levels of energy are restored.
  • Flu-like symptoms: The combination of feeling dizzy, nauseous, achy, hot flashes, and vomiting – may lead you to believe that you’ve contracted the flu. In fact, some people end up thinking that they actually have the flu until they realize that these symptoms coincidentally emerged after they stopped taking Invega.  Realize that these symptoms tend to significantly subside after a few weeks.
  • Hallucinations: Since this medication is commonly prescribed for the treatment of schizophrenia, many people may experience a relapse in symptoms upon discontinuation. Invega is thought to effectively manage hallucinations due to its potent antagonist effect on the D2 receptor.  Upon cessation of the drug, hallucinations may be increasingly intense.  Therefore it is recommended to discontinue under close supervision of a psychiatrist.
  • Headaches: Those that discontinue Invega rapidly may experience severe headaches perceived as migraines. Others may experience less debilitating, brief headaches.  To cope with the headaches, it is recommended to stay hydrated, do your best to stay relaxed, get proper sleep, and eat a healthy diet.  Keep in mind that anxiety may increase muscle tension and exacerbate headaches.
  • Heart palpitations: Upon discontinuation of Invega, you may experience anxiety over changes in your heartbeat. It may feel as if your heart is skipping a beat, fluttering, or beating especially harder than usual.  Heart palpitations are common when discontinuing any psychiatric drug, and may be exacerbated by anxiety.
  • Hot flashes: Some people will feel as if they develop a mild fever upon discontinuation or other changes in bodily temperature. You may experience hot flashes characterized by sudden, unexpected feelings of bodily heat.  In other cases you may experience cold flashes, or brief feelings of cold body temperature accompanied by chills.
  • Insomnia: Many people notice that taking Invega makes them feel sedated and sleepy. Upon discontinuation, some people experience the exact opposite of sedation, feeling exceptionally aroused.  This increase in arousal and dopaminergic activity can cause debilitating insomnia as a withdrawal symptom.  It has been speculated that a sudden halting of the adrenergic antagonism (experienced while on the drug) may contribute to this symptom.
  • Irritability: Withdrawing from a potent antipsychotic like Invega may cause some people to feel irritable. The irritability may be due to the fact that the drug is no longer antagonizing various dopaminergic and serotonergic receptors.  Those that struggled with irritability prior to using Invega may notice that the irritability experienced during withdrawal is even more intense.
  • Itchiness: An uncomfortable reaction to Invega withdrawal is that of itching and/or a skin rash. While this reaction most commonly occurs while taking the medication, it could persist for awhile after you’ve stopped the drug.  Should you start to itch, talk to your doctor about what can be done to reduce it.
  • Memory problems: It should come as no surprise that users report memory problems while taking Invega, as well as while discontinuing. There is evidence that antipsychotics cause brain damage, possibly leading to permanent memory impairment.  In many cases, memory deficits linger long after antipsychotic usage, but can recover for some individuals after several months of withdrawal.
  • Mood swings: Nearly everyone will notice that their mood becomes unpredictable during withdrawal. One minute they may feel angry and another they may feel anxious.  Moods are subject to significant fluctuation during withdrawal due to the fact that the nervous system and brain are attempting to restore homeostasis.  As changes are made to neurotransmitter levels and neural pathways, moods are subject to change.  Generally, moods tend to become more stabilized in time (assuming that the individual doesn’t have bipolar disorder).
  • Muscle pain: A physical reaction that people experience when quitting Invega is muscle pain. Don’t be surprised if you feel body aches and joint pain as well.  The achiness and feeling of physical malaise tends to improve after several weeks as the body learns to function without being under the influence of the drug.
  • Nausea: It is common to feel nauseous when withdrawing from Invega. The nausea may be especially wicked during the first week of discontinuation.  Some people experience nausea so severe, that they end up vomiting.  Those that gradually taper off of Invega should be able to minimize the likelihood of nausea, whereas cold turkey discontinuation nearly guarantees it.
  • Restlessness: You may notice that feelings of nervousness and anxiety are debilitating during withdrawal and trigger restlessness. Assuming you become restless or unable to sit still, you may want to engage in physical exercise to burn some of that nervous energy.  If you feel restless, but can’t push yourself to exercise, consider a breathing exercise to relax your body.
  • Sleep problems: It is common to experience sleep difficulties following cessation of Invega. Some people may find that they cannot get enough sleep, while others will realize that they cannot stop sleeping.  Don’t be surprised if your circadian rhythm becomes imbalanced during withdrawal, resulting in either insufficient or excess sleep.
  • Suicidal thoughts: Some people end up becoming severely depressed during withdrawal and feel as if they want to die. If you feel suicidal, it is recommended to seek immediate medical attention.  With proper professional intervention, these withdrawal-induced suicidal thoughts can be managed and overcome.  Assuming they emerged during withdrawal and you didn’t have them prior to the drug, they are likely to diminish.
  • Sweating: You may notice that you begin to sweat profusely after you quit Invega. The sweating is thought to be a natural bodily detoxification mechanism and may promote healing.  However, it is also important to consider that the sweating could be a reaction associated with physical tolerance to the drug.  Many people wake up in a pool of sweat during the night, while others may notice that they’re dripping with sweat during the day.
  • Tremors: Some people experience tremors or “shakes” when they stop taking Invega. If your limbs and/or body start to shake uncontrollably upon discontinuation, it’s likely related to withdrawal.  These tremors are a physiological reaction associated with detoxification from a drug that your body was still expecting to receive.  Most people find that the shakiness diminishes within several weeks.
  • Vomiting: Those who discontinue Invega may end up vomiting for the first week. Vomiting is especially common among those who quit cold turkey from higher doses.  To minimize the likelihood that you’ll end up puking, consider gradually tapering off of the drug.
  • Weight changes: It is well documented that Invega causes weight gain in a certain percentage of users. Assuming you gained weight while taking the drug, you may end up losing weight upon discontinuation.  If you lost weight from the drug, you may end up gaining the weight back that you lost.  This is due to the fact that your physiology is no longer influenced by Invega.

How long do Invega withdrawal symptoms last? (Duration)

Everyone wants a concise timeline letting them know when to expect certain symptoms to appear, when to expect certain symptoms to fade, and when to expect the withdrawal to be over.  Unfortunately, there is no such timeline due to the fact that withdrawal is subject to variability based on the individual.  Some users have reported that withdrawal symptoms from Invega only last several weeks, while others have reported that symptoms lasted nearly a full year following their last dose.

As a general rule of thumb, you may want to use 90 days as a good checkpoint for reevaluation of withdrawal symptoms.  While three months may seem like a long-time, it is important to consider how long you had taken the drug, as well as the numerous changes it made to your neurochemistry.  It takes time to restore homeostatic neurochemistry as well as physiology following discontinuation of a potent antipsychotic like Invega.

Additionally, a timetable of several months before reevaluating withdrawal symptoms allows you to see the bigger picture of your recovery.  Attempting to track day-to-day, or even week-to-week changes may be highly discouraging due to the fact that change doesn’t occur overnight.  I recommend writing in a Journal to track your recovery over a longer period of time.

In addition, you’ll want to keep working with your psychiatrist and regularly see a psychotherapist to discuss your experience.  Make sure that you’re doing everything in your power to enhance recovery (diet, exercise, work, social, sleep, stress reduction).  If withdrawal seems tough, take things one day, one hour, or even one minute at a time.

Have you experienced Invega withdrawal symptoms?

If you’ve discontinued Invega, feel free to leave a comment mentioning whether you experienced any withdrawal symptoms.  To help others understand your situation, mention why you were taking Invega, the dosage, and how long you took it.  Also discuss how quickly you tapered, the most debilitating withdrawal symptoms you experienced, and how long they lasted before you noticed improvement.