Drug & supplement interaction

Lithium + Paliperidone Palmitate

Paliperidone Palmitate brand name: Invega Trinza.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Lithium has a moderate interaction with Paliperidone Palmitate. Theoretically, taking lithium supplements with antipsychotic drugs might increase the risk of encephalopathic syndrome.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Lithium and Paliperidone Palmitate

Here is the interaction we found between these two, with the evidence behind it.

Moderate

ANTIPSYCHOTIC DRUGS

Why this applies to Paliperidone Palmitate

Paliperidone Palmitate falls under ANTIPSYCHOTIC DRUGS — the group Lithium interacts with.

Theoretically, taking lithium supplements with antipsychotic drugs might increase the risk of encephalopathic syndrome.
Encephalopathic syndrome has been reported in multiple patients taking prescription lithium and antipsychotics concomitantly. Symptoms have included weakness and lethargy, fever, confusion, and extrapyramidal symptoms. In some patients, resulting brain damage was irreversible. Although there is no established causal relationship between these symptoms and the combination of lithium and antipsychotic medications, there is a theoretical relationship. It is unclear if this interaction would occur with the smaller doses found in lithium supplements.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the situation with your Invega Trinza injection and a lithium supplement. Over the years, doctors have seen rare cases where people taking prescription lithium alongside an antipsychotic developed something called encephalopathic syndrome. That can show up as unusual weakness, sluggishness, fever, confusion, or worsening muscle stiffness and tremors (the same extrapyramidal symptoms paliperidone itself can sometimes cause). In a few reports the damage didn't fully reverse, which is why we take it seriously even though it's uncommon.

I want to be honest about the evidence, though. This is mostly theoretical and based on scattered case reports, and nobody has proven the combination actually causes it. We also don't know whether the small amounts in supplements like lithium orotate carry the same risk. Before adding any lithium product, please run it by your prescriber or pharmacist first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/017812s028,018421s027lbl.pdf. Accessed Nov. 21, 2018

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Lithium Also Interacts With Other Medications

Lithium has 259 major, 255 moderate known drug interactions in our database — the Paliperidone Palmitate one above is one of them. If you take anything else, check it against the full list below.

Major 259 Moderate 255 No known interaction 2,316 (incl. Paliperidone Palmitate)
Taking anything else?

Check Another of Your Medications Against Lithium

Covers the 2,830 medications we’ve checked against Lithium. Pick one to open its full report.

From our Q&A

Questions About Lithium or Paliperidone Palmitate

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Lithium or Paliperidone Palmitate, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Paliperidone Palmitate

This page covers Lithium only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Paliperidone Palmitate page lists 27 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: American Hellebore (major), Arsenic (major), Cesium (major), Ephedra (major) and Grapefruit (major).

By severity: 8 major · 18 moderate · 1 minor.

From our pharmacist’s overview on the Paliperidone Palmitate page

“Paliperidone palmitate (Invega Trinza), a long-acting injection for schizophrenia, can lengthen the heart's QT interval on its own, so the supplements on this page deserve real care rather than casual curiosity. Nearly half of the interacting ingredients can stretch that interval further and raise the risk of a dangerous heart rhythm,…”

Reviewed by 2 · Jul 18, 2026

Open the Paliperidone Palmitate interaction page

One more smart check

Taking Lithium as Part of a Dietary Supplement Product? Check It for Interactions

We hold 330 real supplement products containing Lithium, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Lithium. Your product may carry other ingredients that interact with Paliperidone Palmitate too, on top of Lithium — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Lithium and Paliperidone Palmitate Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Lithium
Top 25%

#255 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Paliperidone Palmitate
Top half

#1,071 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Lithium

What is Lithium?

Lithium
  • Mood support
  • Bipolar disorder (prescription)
  • Healthy mental function
  • Irritability or stress
  • Sleep support

Lithium is a naturally occurring metal that, in prescription form (lithium carbonate or citrate), is an FDA-approved, well-proven treatment for bipolar disorder. Low-dose supplement forms like lithium orotate are sold for mood support, but there is very little reliable evidence that they work, and even small amounts of lithium can be risky for some people. Always talk to a pharmacist or doctor before taking any lithium product.

Read the full Lithium monograph & all interactions
Medication

About Paliperidone Injection

What Is Paliperidone Injection Used For?

Brand name: Invega Trinza

Paliperidone injection is used to treat schizophrenia and schizoaffective disorder in adults. Different branded products are approved for specific treatment situations.

Invega Sustenna (once-monthly injection) treats both schizophrenia and schizoaffective disorder. Invega Trinza (every-three-month injection) and Invega Hafyera (every-six-month injection) treat schizophrenia in adults who have already been stabilized on a paliperidone palmitate injectable. Erzofri extended-release is a once-monthly injectable for schizophrenia and schizoaffective disorder in adults.

See full Paliperidone Injection drug information
Keep checking

Other Drugs & Lithium

Browse every other medication we’ve checked against Lithium — both the ones with a known interaction and the ones without. Select any drug for the full detail.

259Major
255Moderate
0Minor
2,315No known interaction
259 Major 255 Moderate 2,315 No interaction
Major

259 interactions

Showing 60 of 259 major interactions — see all 259 on the Lithium page.

Moderate

255 interactions

Showing 60 of 255 moderate interactions — see all 255 on the Lithium page.

No interaction 2,315 drugs checked — show the list

We also checked Lithium against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,315 medications checked with no known interaction — see the full Lithium list.

See the full Lithium interactions page
See every supplement checked against Paliperidone Palmitate, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Lithium monograph › Uses, safety, and every drug interaction in one place Paliperidone Palmitate supplement interactions › Every supplement checked against Paliperidone Palmitate, ranked by severity Paliperidone Injection drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Lithium and Paliperidone Palmitate Together: Common Questions

Can you take Lithium with Paliperidone Palmitate?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Lithium and Paliperidone Palmitate interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Paliperidone Palmitate and Lithium?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.