An Overview with Focus on Discontinuation

Antipsychotic medications like Invega (paliperidone) and Abilify (aripiprazole) can lead to significant side effects, including weight gain. Here’s an examination, focusing on the discontinuation of Invega, both as a standalone treatment and when combined with Abilify:

 

Weight Gain and Health Risks with Invega:

• Mechanism: Invega’s weight gain is attributed to its effects on histamine H1 and serotonin 5-HT2C receptors, leading to increased appetite and reduced satiety (De Hert et al., 2012).
• Prevalence: Clinical data suggests that 10-20% of patients might experience significant weight gain (Correll et al., 2009).

 

Weight Gain with Abilify:

• Mechanism: Abilify has a relatively lower risk of weight gain but can still contribute in some patients (Citrome, 2013).
• Combination Therapy: Combining Invega with Abilify might amplify weight gain due to their combined metabolic effects.

 

Health Risks from Weight Gain:

• Metabolic Syndrome: Increased risk of insulin resistance, dyslipidemia, and hypertension (Meyer & Stahl, 2009).
• Cardiovascular Disease: Heightened risks for cardiovascular events due to weight gain (Correll et al., 2009).
• Diabetes: Potential for developing type 2 diabetes, especially with prolonged use (Newcomer, 2005).

 

Discontinuation of Invega Alone:

• Benefits: Discontinuing Invega might reverse weight gain for some individuals, potentially improving metabolic markers like insulin sensitivity and lipid profiles (Correll et al., 2009).
• Risks:
  • Psychiatric Relapse: The primary concern is the potential for psychiatric symptoms to return or worsen (Viguera et al., 1997).
  • Withdrawal Symptoms: Abrupt cessation might lead to withdrawal symptoms, including anxiety, nausea, or exacerbation of psychosis (Barnes, 1992).

 

Discontinuation of Invega in Patients Previously Stable on Abilify:

• Considerations:
  • Stability on Abilify: If patients were stable on Abilify alone, discontinuing Invega might mitigate side effects like weight gain without compromising psychiatric stability.
  • Monitoring: Careful monitoring post-discontinuation is essential to ensure that Abilify alone continues to manage symptoms effectively.
  • Gradual Tapering: A gradual reduction of Invega is advised to minimize withdrawal effects while assessing the patient’s response to Abilify alone (Viguera et al., 1997).
• Potential Outcomes:
  • Weight Management: Discontinuing Invega could lead to weight loss or stabilization if the weight gain was predominantly due to Invega.
  • Metabolic Health: Improvements in metabolic health might follow if Invega was the primary contributor to metabolic disturbances.

 

Management Strategies:

• Regular Health Checks: Ongoing monitoring of weight, metabolic markers, and psychiatric symptoms is vital.
• Lifestyle Interventions: Diet control, exercise, and possibly behavioral therapy remain crucial, regardless of medication status.
• Alternative Medications: If discontinuing Invega, exploring alternatives with a better side effect profile or non-pharmacological treatments might be considered.

 

Conclusion:

While discontinuing Invega could address weight gain and related metabolic issues, it must be done cautiously, especially considering patients’ psychiatric history and response to Abilify. Each case requires a personalized approach, emphasizing the balance between managing side effects and ensuring psychiatric stability.