2. Second Generation LAIs Available in Canada
Paliperidone Palmitate (PP)
SG LAIs
Availability
Initiation
Kit contains
• 1 Pre-filled syringe
• 2 needles
• 1” 23G or 1.5” 22G (depending on patient weight and
injection site)
Day 1: 150 mg by deep IM deltoid injection
Day 8: 100 mg by deep IM deltoid injection
• 50, 75, 100 & 150 mg
• For patients who have never taken oral paliperidone or
oral/injectable risperidone, it is recommended to establish
tolerability with oral paliperidone or oral risperidone prior
to initiating treatment
• Store at room temperature
• Absorption better from the deltoid injection especially during
initial doses
Oral Supplement
Dosing & Adjustments
• Oral supplementation is not required at initiation
(as per PM)
• Monthly dosing (50-150 mg) IM Gluteal or Deltoid
• First episode patients may require lower doses
• Clinically some patients (ie. acutely ill, previously on high
dose medication, those showing breakthrough symptoms)
may require oral supplementation at initiation
• Adjustment of the maintenance dose may be made monthly
• When making dose adjustments, the prolonged-release
characteristics should be considered, as the full effect of
the dose may not be evident for several months

3. Second Generation LAIs Available in Canada (cont’d)
Availability
Initiation
Kit contains:
• 1 vial of Risperidone microspheres
• 1 prefilled syringe containing diluent
• 2 needles
• 2” 20G (gluteal)
• 1” 21G (deltoid)
Risperidone Microspheres (RLAI)
SG LAIs
• 25 mg every 2 weeks by deep IM injection; gluteal
or deltoid
• 12.5, 25, 37.5 & 50 mg
• Keep refrigerated (2-8 degrees Celsius). Bring to room
temperature before injection
• Use within 6 hours of reconstituting the preparation
• Can stay up to 7 days outside of the refrigerator at
temperatures no greater than 25 degrees Celsius
Oral Supplement
Dosing & Adjustments
• Oral supplementation should be continued for 3 weeks
after the first injection
• Dose can be adjusted monthly [dose range: 25, 37.5, 50 mg
(maximum)]
• Some experts advocate gradual tapering after 3 weeks.
Patients showing breakthrough symptoms may require
longer period of oral supplementation until the effective
dose of LAI has been established
• In clinical practice, doses of 75 mg have been used for
patients who have shown good tolerability but require
higher dose for full clinical response
• Patient should be continued on lowest dose needed
• Upward dose adjustment should not be made more
frequently than every 4 weeks. The clinical effects of this
dose adjustment should not be anticipated earlier than 3
weeks after the 1st injection with the higher dose.

4. Switching to SG LAIs from an Oral
Antipsychotic
Paliperidone Palmitate (PP)
Paliperidone
Palmitate 150 mg (deltoid)
Stop Oral
Paliperidone
Palmitate 100 mg (deltoid)
Patient
on oral
DAY 1
Flexible
50 - 150 mg
(deltoid or gluteal)
Flexible
50 - 150 mg
(deltoid or gluteal)
DAY 8
(+/- 2 to 4 days)*
4 WEEKS
LATER
MONTHLY
(+/- 7 days)*
*To avoid a missed dose
Risperidone Microspheres (RLAI)
Risperidone Microspheres 25 mg
(deltoid or gluteal)
Risperidone Microspheres 25 mg
(deltoid or gluteal)
Stop Oral
Patient
on oral
DAY 1
DAY 14
(WEEK 2)
DAY 21
Flexible 25-50 mg
(deltoid or gluteal)
Flexible 25-50 mg
(deltoid or gluteal)
Flexible 25-50 mg
(deltoid or gluteal)
DAY 28
WEEK 4
EVERY 2
WEEKS
EVERY 2
WEEKS
Approximate conversion: Risperidone oral 2-3 mg (25 mg RLAI), Risperidone oral 4-5 mg (37.5mg RLAI), Risperidone oral 6 mg and over (50 mg RLAI)
These ratios are approximate and may not work for some patients.

5. Switching Between LAI’s
 Tolerability should be established with oral paliperidone
or oral risperidone for patients who have never taken
these agents
 When switching patients who are on a stable dose of a
long-acting injectable, initiate paliperidone palmitate
therapy in place of the next scheduled injection then
continue at monthly intervals
 The one-week initiation dosing regimen is not required
INVEGA SUSTENNA® Product Monograph, Dec 30, 2013.

6. Switching Between LAI’s (cont’d)
Approximate dose equivalence between risperidone microspheres
and paliperidone palmitate (as per PM)
Previous Risperidone
Microspheres Dose
Paliperidone Palmitate
Dose
25 mg every 2 weeks
50 mg eq. monthly
37.5 mg every 2 weeks
75 mg eq. monthly
50 mg every 2 weeks
100 mg eq. monthly
Switching early psychosis patients from risperidone microspheres to paliperidone palmitate may require more careful
dose adjustment
For patients on FG LAIs being switched to SG LAIs it is recommended that they have the injection
on the next scheduled injection day and follow the dosing regimen of SG LAI. Dose is dependent on
whether the patient is on low, average or high dose of FG LAI
INVEGA SUSTENNA® Product Monograph, Dec 30, 2013.

8. Click here to complete
Module 3