Paliperidone (Invega) and Ketamine Therapy | Tovani Health
Invega (Paliperidone) (also: Invega Sustenna, Invega Trinza) — Atypical antipsychotic (active metabolite of risperidone)
Verdict at Tovani Health
Compatible; same profile as risperidone since paliperidone is risperidone's active metabolite.
Paliperidone and ketamine are compatible. Paliperidone is the active metabolite of risperidone, so the interaction profile is essentially identical: D2 antagonism may modestly attenuate ketamine's antidepressant response, and there is modest QT and orthostatic considerations. Long-acting injectable forms (Sustenna, Trinza) mean the medication is on board continuously between injections.
If you take Invega regularly and are considering at-home ketamine therapy, the combination is safe with monitoring or dose adjustment. This page covers the brief pharmacologic context and what we do at intake.
How Invega interacts with ketamine
Paliperidone antagonizes D2 and 5-HT2A receptors. Like risperidone, modest QT prolongation and orthostatic hypotension are the dominant side effects. Long-acting injectable formulations provide steady-state coverage.
What we do at intake
Disclose dose, formulation (oral, monthly LAI, 3-month LAI), and last injection date if applicable. Baseline EKG if over 50 or on other QT agents.
Bottom line
Paliperidone and ketamine are compatible. Paliperidone is the active metabolite of risperidone, so the interaction profile is essentially identical: D2 antagonism may modestly attenuate ketamine's antidepressant response, and there is modest QT and orthostatic considerations. Long-acting injectable forms (Sustenna, Trinza) mean the medication is on board continuously between injections.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Invega (Paliperidone) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Sources
The verdict and clinical guidance on this page are based on the following peer-reviewed literature and FDA prescribing information.
- Pharmacodynamic Interactions Between Ketamine and Psychiatric Medications Used in the Treatment of Depression. Veraart JKE, Smith-Apeldoorn SY, et al.. International Journal of Neuropsychopharmacology. 2021. PMID: 34170315
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 16, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.