Drugs Having Clinically Important Interactions with INVEGA TRINZA: Because paliperidone palmitate is hydrolyzed to paliperidone (see Pharmacology: Pharmacokinetics under Actions), results from studies with oral paliperidone should be taken into consideration when assessing drug-drug interaction potential. In addition, consider the 3-month dosing interval and long half-life of INVEGA TRINZA (see Administration Instructions under Dosage & Administration and Pharmacology: Pharmacokinetics under Actions). (See Table 11.)
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Drugs Having No Clinically Important Interactions with INVEGA TRINZA: Based on pharmacokinetic studies with oral paliperidone, no dosage adjustment of INVEGA TRINZA is required when administered concomitantly with valproate (see Pharmacology: Pharmacokinetics under Actions). Additionally, no dosage adjustment is necessary for valproate when co-administered with INVEGA TRINZA (see Pharmacology: Pharmacokinetics under Actions).
Pharmacokinetic interaction between lithium and INVEGA TRINZA is unlikely.
Paliperidone is not expected to cause clinically important pharmacokinetic interactions with drugs that are metabolized by cytochrome P450 isozymes. In vitro studies indicate that CYP2D6 and CYP3A4 may be involved in paliperidone metabolism; however, there is no evidence in vivo that inhibitors of these enzymes significantly affect the metabolism of paliperidone. Paliperidone is not a substrate of CYP1A2, CYP2A6, CYP2C9, and CYP2C19; an interaction with inhibitors or inducers of these isozymes is unlikely. (See Pharmacology: Pharmacokinetics under Actions.)