Conversely, on discontinuation of the strong inducer, it may be necessary to decrease the dose of INVEGA. Some patients may benefit from lower initiation doses within the available strengths (39 mg, 78 mg, 117 mg, and 156 mg). References:1. comment sorted by Best Top New Controversial Q&A Add a Comment NotConnor365 depressive subtype Commonly Observed Adverse Reactions for RISPERDAL CONSTA: The most common adverse reactions in clinical trials in patients with schizophrenia (5%) were headache, Parkinsonism, dizziness, akathisia, fatigue, constipation, dyspepsia, sedation, weight increase, pain in extremities, and dry mouth. I have always wanted a clinical tool that offered a blueprint for cross-tapering from one antipsychotic medication to another, and particularly one that took medication half-life into account. Samtani MN, et al. No adverse events occurred at a rate of 5% and twice placebo during the 15-month double-blind, placebo-controlled study in patients with schizoaffective disorder. Hyperprolactinemia: As with other drugs that antagonize dopamine D2 receptors, INVEGA TRINZAand INVEGA SUSTENNA elevateprolactin levels, and the elevation persists during chronic administration. From risperidone tablets to INVEGASUSTENNA, Recommended dosing of INVEGASUSTENNA for adults with schizophrenia transitioning from risperidone tablets1,2. Hyperprolactinemia: As with other drugs that antagonize dopamine D2 receptors, INVEGA SUSTENNA elevates prolactin levels, and the elevation persists during chronic administration. Maintenance Treatment: Physicians who elect to use RISPERDAL for extended periods should periodically re-evaluate the long-term risks and benefits of the drug for the individual patient. Consider discontinuing INVEGA TRINZA and INVEGA SUSTENNA at the first sign of a clinically significant decline in WBC in the absence of other causative factors. Russu A, Kern Sliwa J, Ravenstijn P, et al. Commonly observed adverse reactions (incidence 5% and at least twice that for placebo in adults with schizophrenia) were: extrapyramidal symptoms, tachycardia, and akathisia. (dose range 175-525mg) Consider either: Invega Sustenna 25-150mg IM q month OR Abililfy Maintena 300-400mg IM q month OR Risperdal Consta 12.5mg-50mg IM q 14 days The benefits of breastfeeding should be considered along with the mothers clinical need for INVEGA SUSTENNA and any potential adverse effects on the breastfed infant from INVEGA SUSTENNA or the mothers underlying condition. Neuroleptic Malignant Syndrome (NMS): NMS, a potentially fatal symptom complex, has been reported in association with antipsychotic drugs, including paliperidone. Falls:Somnolence, postural hypotension, motor and sensory instability have been reported with the use of antipsychotics, including INVEGA SUSTENNA, which may lead to falls and, consequently, fractures or other fall-related injuries. INVEGA can pass into human breast milk. Supplementation with an oral antipsychotic is required during the initiation of Abilify Maintena, Introduction. 1 A third common indication is patient and/or caregiver request. RISPERDAL is not approved for use in patients with dementia-related psychosis. For optimal user experience, please log into the DTP portal using Google Chrome as your browser. Patients with clinically significant neutropenia should be carefully monitored for fever or other symptoms or signs of infection and treated promptly. The purpose of VA PBM Services drug monographs is to provide a comprehensive drug review for making formulary decisions. INVEGA SUSTENNA [Prescribing Information]. Falls: Somnolence, postural hypotension, motor and sensory instability have been reported withthe use of antipsychotics, including INVEGA, which may lead to falls and, consequently,fractures or other fall-related injuries. Patients starting treatment with APS who have or are at risk for diabetes mellitus should undergo fasting blood glucose testing at the beginning of and during treatment. Agranulocytosis has also been reported. More common side effects in people taking Invega for schizoaffective disorder include: extrapyramidal symptoms. Please click here to read the full Prescribing Information, including Boxed WARNING, for INVEGA. Dysphagia: Esophageal dysmotility and aspiration have been associated with antipsychotic drug use. Avoid theuse of drugs that also increase QTc interval and in patients with risk factors for prolonged QTc interval. If signs and symptoms of TD appear in a patient on INVEGA, drug discontinuation should be considered. Please see fullPrescribing Information, including Boxed WARNING, for RISPERDAL. I am very big but i have just randomly lost 3 stone after being on abilify 10mg and on respiridone 2mg and Valium 2mg ;When required Fern; Jan 26, 2022; Psychosis Forum; 2 3. IMPORTANT SAFETY INFORMATION FOR INVEGA (paliperidone). Some patients require continuation of antidiabetic treatment despite discontinuation of the suspect drug. Click Continue below to be taken to another indication for INVEGA SUSTENNA for schizophrenia in adults. This information is based on pharmacokinetic (PK) modeling performed to compare steady-state exposure during maintenance treatment between risperidone tablets and INVEGASUSTENNA (after both the 234 mg/156 mg deltoid starting doses). This year i was put on invega sustenna (injection) and i gained a little weight despite taking magnesium citrate for regular bowel movements. Invega Sustenna (paliperidone palmitate monthly LAI): . If NMS is suspected, immediately discontinue INVEGA SUSTENNA and provide symptomatic treatment and monitoring. INVEGA should only be used in patients who are able to swallow the tablet whole. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Legal Notice |Privacy Policy |Medical Information Center. How to step down asthma preventer treatment in patients with well-controlled asthma - more is not always better Sodium-glucose co-transporter 2 inhibitors beyond diabetes Therapeutics for rheumatic fever and rheumatic heart disease Provides health professionals with timely, independent and evidence-based information All articles Latest Articles CNS Drugs. Hyperprolactinemia: As with other drugs that antagonize dopamine D2 receptors, RISPERDAL elevates prolactin levels and the elevation persists during chronic administration. Patients should be advised that there is a pregnancy registry that monitors outcomes in women exposed to INVEGA HAFYERA during pregnancy. Discontinuation should be considered at the first sign of a clinically significant decline in WBC in the absence of other causative factors. All patients treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia. Seizures:INVEGA SUSTENNA should be used cautiously in patients with a history of seizures or with conditions that potentially lower seizure threshold. For patients, particularly the elderly, with diseases, conditions, or medications that could exacerbate these effects, assess the risk of falls when initiating antipsychotic treatment and recurrently for patients on long-term antipsychotic therapy. Some patients require continuation of anti-diabetic treatment despite discontinuation of the suspect drug. At first, everything was fine on the drug but now I've been trying to get my psychiatrist to switch my meds for months because it's . See full prescribing information . You are currently not accessing the Outpatient Sample Program portal with Google Chrome. Since RISPERDAL has the potential to impair judgment, thinking or motor skills, patients should be cautioned about operating hazardous machinery, including automobiles, until they are reasonably certain that RISPERDAL therapy does not affect them adversely. In placebo-controlled trials, there was a significantly higher incidence of cerebrovascular adverse events in patients treated with risperidone compared to patients treated with placebo. . IMPORTANT SAFETY INFORMATION and INDICATION for RISPERDALCONSTA (risperidone). Patients in . The benefits of breastfeeding should be considered along with the mothers clinical need for INVEGA and any potential adverse effects on the breastfed infant from INVEGA or the mothers underlying condition. Contraindications: INVEGA HAFYERA is contraindicated in patients with a known hypersensitivity to either paliperidone, risperidone, or to any excipients of their formulation. Jul . Contraindications: Paliperidone is contraindicated in patients with a known hypersensitivity to paliperidone, risperidone, or to any excipients in INVEGA. These medicines are not approved for the treatment of patients with dementia-related psychosis. Monitoring should be considered in patients for whom this may be of concern. Drug Interactions:Strong CYP3A4/P-glycoprotein (P-gp) inducers: Avoid using a strong inducer of CYP3A4 and/or P-gp (e.g. Contraindications: INVEGA SUSTENNA is contraindicated in patients with a known hypersensitivity to either paliperidone, risperidone, or to any excipients of the INVEGA SUSTENNA formulation. They are both injections, and I think I'm in the position to switch Press J to jump to the feed. QT Prolongation: Paliperidone causes a modest increase in the corrected QT (QTc) interval. In patients who do require chronic treatment, use the lowest dose and the shortest duration of treatment producing a satisfactory clinical response. Drug Interactions:Strong CYP3A4/P-glycoprotein (P-gp) inducers: Avoid using a strong inducer ofCYP3A4 and/or P-gp (e.g., carbamazepine, rifampin, St Johns Wort) during a dosing interval for INVEGA TRINZA or INVEGA SUSTENNA. ABILIFY MAINTENA is to be administered by either deep intramuscular deltoid or gluteal injection by a healthcare professional After the first injection of ABILIFY MAINTENA, treatment with oral aripiprazole (10 mg to 20 mg) or current oral antipsychotic should be continued for 14 consecutive days Body Temperature Regulation: Disruption of body temperature regulation has been attributed to antipsychotic agents. However, some patients may require treatment with RISPERDAL CONSTA despite the presence of the syndrome. RISPERDAL CONSTA (risperidone) long-acting injection is indicated for the treatment of schizophrenia. Patients with severe neutropenia (absolute neutrophilcount <1000/mm3) should discontinue RISPERDAL CONSTA and have their WBC followeduntil recovery. Falls: Somnolence, postural hypotension, motor and sensory instability have been reported withthe use of antipsychotics, including RISPERDAL CONSTA, which may lead to falls and,consequently, fractures or other fall-related injuries. Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. Fertility:RISPERDAL may cause a reversible reduction in fertility in females. Hyperglycemia and Diabetes Mellitus: Hyperglycemia and diabetes mellitus, in some casesextreme and associated with ketoacidosis, hyperosmolar coma or death, have been reported inpatients treated with all atypical antipsychotics (APS). Dysphagia: Esophageal dysmotility and aspiration have been associated with antipsychotic drug use. RISPERDAL CONSTA is not approved for the treatment of patients with dementia-related psychosis. The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown. Abilify prices the cost for abilify oral tablet, disintegrating 60 mg-75 mg is around 0 for a supply of tablets, depending on the pharmacy you visit. Please see fullPrescribing Information, including Boxed WARNING, for INVEGA. Body Temperature Regulation: Disruption of body temperature regulation has been attributed to antipsychotic agents. Cerebrovascular Adverse Events (CAEs): CAEs (eg, stroke, transient ischemia attacks), including fatalities, were reported in placebo-controlled trials in elderly patients with dementia-related psychosis taking oral risperidone, aripiprazole, and olanzapine. Thank you. (5.1). Potential for Cognitive and Motor Impairment: Somnolence, sedation, and dizziness were reported as adverse reactions in subjects treated with INVEGA SUSTENNA. INDICATIONS. INVEGA SUSTENNA can pass into human breast milk. Pregnancy/Nursing: INVEGA HAFYERA may cause extrapyramidal and/orwithdrawal symptoms in neonates with third trimester exposure. The benefits of breastfeeding should be considered along with the mothers clinical need for INVEGA TRINZA or INVEGA SUSTENNA and any potential adverse effect on the breastfed infant from INVEGA TRINZA or INVEGA SUSTENNA or the mothers underlying condition. INVEGA should be used with caution in patients with known cardiovascular disease (eg, heart failure, history of MI or ischemia, conduction abnormalities), cerebrovascular disease or conditions that would predispose patients to hypotension (eg, dehydration, hypovolemia, treatment with anti-hypertensive medications). QT Prolongation: Paliperidone causes a modest increase in the corrected QT (QTc) interval. Patients should be cautioned about performing activities that require mental alertness such as operating hazardous machinery, including motor vehicles, until they are reasonably certain that INVEGA TRINZA and INVEGA SUSTENNA do not adversely affect them. Treated with INVEGA SUSTENNA If the Last Dose of INVEGA SUSTENNA is: Initiate INVEGA TRINZA at the Following Dose: 78 mg 273 mg 117 mg 410 mg 156 mg 546 mg 234 mg 819 mg Conversion from the INVEGA SUSTENNA. If last dose of PP3M was 819 mg, initial dose of Invega Hafyera is 1,560 mg. The incidence of CAEs was significantly higher than with placebo. Patients who have never taken paliperidone or risperidone (in any form) should receive oral doses of one or the other prior to starting IM paliperidone palmitate (See above: Initiation in paliperidone or risperidone nave patient) The risk of developing TD and the likelihood that it will become irreversible appear to increase with the duration of treatment and the cumulative dose. Long-acting injectables (LAIs) are Injectable medications used for individuals living with mental illness. Certain circumstances may increase the risk of the occurrence of torsades de pointes and/or sudden death in association with the use of drugs that prolong the QTc interval. Monitor patients closely for adverse reactions and discontinue the regimen as soon as possible if a severe adverse reaction occurs. Hyperglycemia and Diabetes Mellitus: Hyperglycemia and diabetes mellitus, in some cases extreme and associated with ketoacidosis, hyperosmolar coma or death, have been reported in patients treated with atypical antipsychotics (APS). Cerebrovascular Adverse Reactions: Cerebrovascular adverse reactions (e.g., stroke, transient ischemic attacks), including fatalities, were reported at a higher incidence in elderly patients with dementia-related psychosis taking risperidone, aripiprazole, and olanzapine compared to placebo. A difference is that Abilify is also used to treat mania, depression, bipolar disorders, autistic disorders, and some irritable behavior disorders. Paliperidone extended-release injection (Invega Sustenna) is also used alone or with other medications to treat schizoaffective disorder (a mental illness that causes both a loss of contact with reality and mood problems [depression or mania]). In patients who do require chronic treatment, use the lowest dose and the shortest duration of treatment producing a satisfactory clinical response. VA Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives. *The first monthly maintenance dose should be administered 5 weeks after the first injection (regardless of the timing of the second injection). From long-acting injectable (LAI) antipsychotic to INVEGASUSTENNA. These 2 LAIs have different pharmacologic activities: aripiprazole is a partial agonist at dopamine D 2 and serotonin 5HT 1A receptors and antagonist at 5HT 2A receptors (Abilify Maintena Prescribing Information, 2016), whereas paliperidone is an antagonist at D 2 and 5HT 2A receptors (Invega Sustenna Prescribing Information, 2015). 1. INVEGA HAFYERA can pass into human breast milk. Pregnancy/Nursing:INVEGA SUSTENNA may cause extrapyramidal and/or withdrawal symptoms in neonates with third trimester exposure. How do I switch from oral Abilify to Maintena? INVEGA SUSTENNA (paliperidone palmitate) is indicated for the treatment of: IMPORTANT SAFETY INFORMATION FOR INVEGA SUSTENNA (paliperidone palmitate). Janssen Pharmaceuticals, Inc. . . Cerebrovascular Adverse Reactions: Cerebrovascular adverse reactions (e.g., stroke, transient ischemic attacks), including fatalities, were reported at a higher incidence in elderly patients with dementia-related psychosis taking risperidone, aripiprazole, and olanzapine compared to placebo. ABILIFY MAINTENA (aripiprazole) is a prescription medicine given by injection by a healthcare professional for: treatment of schizophrenia in adults. Paliperidone (Invega) is available as a lower-cost generic. Whether antipsychotic drug products differ in their potential to cause tardive dyskinesia is unknown. The following adverse reactions occurred more frequently (a 2% difference vs. placebo) in the long-term study in patients with schizoaffective disorder: weight increased, nasopharyngitis, headache, hyperprolactinemia, and pyrexia. Paliperidone (Invega) is taken by mouth and used to improve mood, thoughts, and behaviors in schizophrenia and schizoaffective disorder. Chlorpromazine equivalents help guide clinicians in estimating an approximately equivalent dose when transitioning from one antipsychotic to another. Risperidone is associated with higher levels of prolactin elevation than other antipsychotic agents. Patients starting treatment with APS who have or are at risk for diabetes mellitus should undergo fasting blood glucose testing at the beginning of and during treatment. Avoid the use of drugs that also increase QTc interval and in patients with risk factors for prolonged QTc interval. Patients starting treatment with APS who have or are at risk for diabetes mellitus should undergo fasting blood glucose testing at the beginning of and during treatment. Patients with a history of clinically significant low white bloodcell count (WBC) or drug-induced leukopenia/neutropenia should have frequent complete bloodcell counts during the first few months of therapy. (5.1). The recommended maintenance dose for treatment of schizophrenia is 117 mg. Possible risk factors for leukopenia/neutropenia include pre-existing low white blood cell count (WBC) or drug-induced leukopenia/neutropenia. 1. Abilify Maintena may also be used for purposes not listed in this medication guide. Falls: Somnolence, postural hypotension, motor and sensory instability have been reported withthe use of antipsychotics, including RISPERDAL, which may lead to falls and,consequently, fractures or other fall-related injuries. Replies 26 Views 1K. INVEGAis an atypical antipsychotic indicated for the treatment of schizophrenia. October 2013; Addendum March 2016. Conditions that lower seizure threshold may be more prevalent in patients 65 years or older. sleepiness. Priapism has been reported. However, some patients may require treatment with INVEGA SUSTENNA despite the presence of the syndrome. If signs and symptoms of TD appear in a patient on INVEGA SUSTENNA or INVEGA TRINZA, drug discontinuation should be considered. If signs and symptoms of TD appear in a patient on RISPERDAL, drug discontinuation should be considered. Aripiprazole Prolonged Release Suspension for Injection (Abilify Maintena) (300 mg and 400 mg Vial) [Internet]. RISPERDAL CONSTA should be used with caution in patients with known cardiovascular disease, cerebrovascular disease or conditions that would predispose patients to hypotension (e.g., dehydration, hypovolemia, treatment with antihypertensive medications). Leukopenia, Neutropenia and Agranulocytosis have been reported with antipsychotics, including INVEGA TRINZA and INVEGA SUSTENNA. Reasons include it is a new practice and each medication has a different injection technique, which requires training. Discontinue INVEGA HAFYERA in patients with severe neutropenia (absolute neutrophil count <1000/mm3) and follow their WBC until recovery. Patients should be advised that there is a pregnancy registry that monitors outcomes in women exposed to RISPERDAL CONSTA during pregnancy. For paliperidone palmitate (Invega Sustenna), many different doses were tried in clinical trials and 25 mg given by injection every four weeks was the minimum dose that was statistically significantly better than placebo, that is, the "minimum effective dose." . All patients treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia. Establish tolerability in patients who have not taken oral paliperidone, oral risperidone, or injectable risperidone.1 Learn about initiation and maintenancedosing for INVEGASUSTENNA. IMPORTANT SAFETY INFORMATION and INDICATION for RISPERDAL(risperidone). Conditions that lower seizure threshold may be more prevalent in patients 65 years or older. Seizures: INVEGA TRINZA and INVEGA SUSTENNA should be used cautiously in patients with ahistory of seizures or with conditions that potentially lower seizure threshold. Advise patients to notify their healthcare professional if they become pregnant or intend to become pregnant during treatment with INVEGA HAFYERA. Increase by 12.5 mg increments if doses >50 mg needed. This information is not included in the INVEGASUSTENNA Prescribing Information. The recommended initiation dosing regimen (234 mg/156 mg on Day 1/Day 8) is not required. Fertility:RISPERDAL CONSTA may cause a reversible reduction in fertility in females. INVEGA TRINZA and INVEGA SUSTENNA have the potential to impair judgment, thinking, or motor skills. Tardive Dyskinesia (TD): TD, a syndrome consisting of potentially irreversible, involuntary, dyskinetic movements, may develop in patients treated with antipsychotic drugs. Antipsychotic treatment itself, however, may suppress (or partially suppress) the signs and symptoms of the syndrome, possibly masking the underlying process. Contraindications: INVEGA TRINZA and INVEGA SUSTENNA are contraindicated in patients with aknown hypersensitivity to either paliperidone, risperidone, or to any excipients of their formulation. TD may remit, partially or completely, if antipsychotic treatment is discontinued. All patients treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia. NEW ORLEANS Switching from monthly Invega Sustenna to Aristada reduced schizophrenia symptoms among individuals with inadequate response or intolerance to Invega Sustenna, according to data . Applies to: Invega Sustenna (paliperidone) You should avoid the use of alcohol while being treated with paliperidone. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Clinical monitoring of weight is recommended. Conditions that lower seizure threshold may be more prevalent in patients 65 years or older. Switching from Abilify Maintena to Aristada The recommended starting and maintenance dose of Abilify Maintena is 400mg a month. INDICATIONS. 3. All rights reserved. DC Invega Sustenna and start Abilify Maintena (aripiprazole ) 400 mg IM monthly (after a few test doses of Abilify oral have been tried and tolerated) with overlapping oral Abilify 10 mg in the MORNING . Switching to billing under the pharmacy benefit resulted in a monthly gain of $2,100. With more long-acting injectable (LAI) antipsychotics available for treating schizophrenia, each with variable durations of action (2 weeks to 3 months), it is important to have clear management strategies for patients developing breakthrough psychotic symptoms or experiencing symptomatic worsening on LAIs. INVEGA HAFYERA should be used with caution in patients with known cardiovascular disease, cerebrovascular disease or conditions that would predispose patients to hypotension (e.g., dehydration, hypovolemia, treatment with antihypertensive medications). (Aristada and Abilify maintena) and of LAI risperidone (Risperdal . Paliperidone (Invega Sustenna) 50 mg: Vial for injection: 317.9100: 75 mg IM once monthly: 17.03 b: 6,216: 75 mg: 476.8700: 100 mg: 476.8700: 150 mg: 635 . Paliperidone has a prolactin-elevating effect similar to risperidone, which is associated with higher levels of prolactin elevation than other antipsychotic agents. INVEGA SUSTENNA (paliperidone palmitate) is an atypical antipsychotic . If signs and symptoms of TD appear in a patient on INVEGA SUSTENNA, drug discontinuation should be considered. Garbled February 25, 2023, 11:37am 1. First Glance-Abilify Maintena (aripiprazole extended-release injectable suspension) Approved Indication For treatment schizophrenia in adults . Please click here to read the full Prescribing Information, including Boxed WARNING, for RISPERDAL CONSTA. Seizures: INVEGA HAFYERAshould be used cautiously in patients with ahistory of seizures or with conditions that potentially lower seizure threshold. studied. Leukopenia, Neutropenia and Agranulocytosis have been reported with antipsychotics, including INVEGA SUSTENNA. Periodically reassess the need for continued treatment. In contrast, aripiprazole injection (9.75 mg per vial) is a short-acting formulation indicated for agitation in patients with schizophrenia or mania. Invega is an extended form of paliperidone - the active metabolite found in Risperdal; these 2 drugs are very similar, so if your son was on Risperdal before and it really did not work for him, chances are that Invega will not work for him either - but this is not always the case, antipsychotics are funny this way. Pregnancy/Nursing:RISPERDAL CONSTA may cause extrapyramidal and/or withdrawal symptoms in neonates with third trimester exposure. Certain circumstances may increase the risk of the occurrence of torsade de pointes and/or sudden death in association with the use of drugs that prolong the QTc interval. By using this offer, you are certifying that you meet the eligibility criteria (not a member of a federal, state, or government insurance program) and will comply with the terms and conditions described in the . If signs and symptoms of TD appear in a patient on RISPERDAL CONSTA, drug discontinuation should be considered. INVEGA SUSTENNA is not approved for use inpatients withdementia-related psychosis. However, some patients may require treatment with INVEGA SUSTENNA or INVEGA TRINZA despite the presence of the syndrome. The benefits of breastfeeding should be considered along with the mothers clinical need for RISPERDAL and any potential adverse effect on the breastfed infant from RISPERDAL or the mothers underlying condition. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status including delirium, and autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). It may also occur after discontinuation. Hyperglycemia and Diabetes Mellitus: Hyperglycemia and diabetes mellitus, some cases extreme and associated with ketoacidosis, hyperosmolar coma or death, have been reported in patients treated with atypical antipsychotics (APS), including RISPERDAL CONSTA. Orthostatic Hypotension and Syncope: RISPERDAL may induce orthostatic hypotension in some patients due to its alpha-blocking activity. Seizures: RISPERDAL should be used cautiously in patients with a history of seizures. 39 mg dose was not . INVEGA HAFYERA, an every-six-month injection, is an atypical antipsychotic indicated for the treatment of schizophrenia in adults after they have been adequately treated with: A once-a-month paliperidone palmitate extended release injectable suspension (e.g., INVEGA SUSTENNA ) for at least four months or.