Risperidone / Paliperidone LAI conversion tables, and why I'm favoring Uzedy
Equivalent dosing for risperidone and paliperidone formulations
Risperidone and Paliperidone Long-Acting Injectable (LAI) products
Medication | Strength | Dosage | PO Overlap | Pain | Max | Route / Site | Details |
RISPERDAL CONSTA (risperidone) | 12.5 mg 25 mg 37.5 mg 50 mg | q 2 wk | 3 wk | No | 50 mg q 2 wk | IM gluteal or deltoid | Consta: Usual starting and maintenance dose is 25 mg q 2 wk. |
RYKINDO (risperidone) | 12.5 mg 25 mg 37.5 mg 50 mg | q 2 wk | 3 wk | No | 50 mg q 2 wk | IM gluteal or deltoid | Rykindo is Equivalent to RISPERDAL CONSTA |
PERSERIS (risperidone) | 90 mg 120 mg | q 4 wk | None needed | Yes | 120 mg q 4 wk | SC abdomen | Perseris is like an injectable implant. Thick 18-gauge needle, leaves a hard palpable lump. |
UZEDY (risperidone) | 50, 75, 100, 125, 150, 200, 250 mg | q 4–8 wk | None needed | Yes | 250 mg q 2 mo | SC abdomen or upper arm | Uzedy therapeutic blood levels are reached within 6 to 24 hr. |
INVEGA SUSTENNA (paliperidone palmitate) | 39 mg 78 mg 117 mg 156 mg 234 mg | q 4 wk | Optional | No | 234 mg monthly | IM with first 2 injections in deltoid for faster distribution, with subsequent injections deltoid or gluteal. | Sustenna standard dose is 234 mg once, then 156 mg on day 8 (with window of day 4 – day 12), then 117 mg monthly thereafter. Gradual rise to maximum serum concentration (Cmax) at 13 days. |
INVEGA TRINZA (paliperidone palmitate) | 273 mg 410 mg 546 mg 819 mg | q 3 mo | N/A— transition from Sustenna | No | 819 mg q 3 mo | IM gluteal or deltoid | Trinza: Must first have received four monthly Sustenna injections, and the last two Sustenna doses must be the same strength. |
INVEGA HAFYERA (paliperidone palmitate) | 1092 mg 1560 mg | q 6 mo | N/A— transition from Trinza | No | 1560 mg q 6 mo | IM gluteal | Hafyera: Must first have received four monthly Sustenna injections or one Trinza injection. |
Uzedy
My mascot for Uzedy derives from the Frankenstein mascot for risperidone. See here for all of the risperidone and paliperidone mascots.
Uzedy is becoming my risperidone/paliperidone LAI product of choice for inpatient administration.
The success rate of intended intramuscular injections is between 32% and 52%, with the rest potentially resulting in inadvertent subcutaneous drug deposition (Soliman et al, 2018). The success rate is even lower in obese patients and women. The LAIs intended for muscles do not release well when deposited outside of muscle. I have seen shockingly low serum drug levels with IM LAIs (not with our nurses, they never miss ☺).
If an injection will likely end up SQ anyhow, why not choose a medication intended for SQ placement?
Advantages of Uzedy (SQ) over Perseris (SQ)
The volume of injection is less with Uzedy
Nurses tell me it is easier to administer Uzedy
Options for 1-month or 2-month treatments (vs 10month with Perseris)
Although Uzedy is available in 50, 75, 100, 125, 250, 200 and 250 mg strengths, I anticipate using mostly 100 mg in the inpatient setting. The 100 mg dose is appropriate for either q1mo (4 mg PO equivalent) or q2mo (2 mg PO equivalent) dosing, and the frequency of treatment can be decided by the outpatient provider.
Disadvantages of Risperdal Consta (generic version), the cheaper option
Consta must be administered every two weeks--the patient is "CONSTAntly getting injections".
A 3-week PO overlap is needed. The patient needs to keep taking oral risperidone beyond the second injection of Risperdal Consta!
Consta is intended for IM injection (see above)
With Uzedy, PO overlap is usually not necessary because serum levels are therapeutic within 6-24 hours of the injection.
What about Invega Trinza (q3 mo) and Invega Hafyera (q6 mo)? There are use cases, but I prefer the flexibility of not being locked into a medication for longer than 2 months.
Disclosures: No current pharmaceutical industry sponsorship
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