False-Positive Fentanyl Drug Test Due To Invega

In our latest question and answer, Dr. Brian Staiger describes how Invega and risperidone can cause false-positive drug test results for fentanyl.

Question

Is there any official government or doctor-written proof that Invega can cause a false positive for fentanyl? I need official records to prove it. I had an Invega shot two months ago and am testing positive for fentanyl for probation. I'm scared of them not believing me without official doctor or government records.

Asked by Lissette On Dec 21, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Dec 21, 2022
Last updated Mar 28, 2025

Key points

  • Both Risperdal (risperidone) and Invega (paliperidone) have published evidence that they can cause false-positive drug results for fentanyl.

Answer

Thanks for reaching out! This a topic we have covered before (one of our prior answers can be found here) and there is certainly published data showing that both risperidone and Invega (paliperidone) can cause false-positive drug tests for fentanyl.

While I don't know of an official government record, the manufacturer of Invega specifically discusses the topic on their official website for the drug, and studies on the topic are published on PubMed, which is maintained by the United States National Library of Medicine at the National Institutes of Health.

Janssen, the manufacturer of Invega, states the following

During a validation study, risperidone and its active metabolite, 9-hydroxy-risperidone (paliperidone - INVEGA), were found to cross-react with the DRI® fentanyl immunoassay. The authors concluded that a similar chemical moiety (3-methyl-5-piperidino-2-pentene) that is shared with fentanyl and acetylfentanyl may be recognized by the antibody for the immunoassay.

INVEGA SUSTENNA – False Positive Urine Drug Screen

The authors of the study that is referenced in the excerpt above recommend that anyone taking risperidone or Invega who tests positive for fentanyl take a confirmatory test to validate (or prove false) the results.

Why Can A False-Positive Happen?

False positives can, unfortunately, happen on immunoassay drug tests simply based on how these tests work.

Essentially, immunoassay-based tests rely on antibodies to react with specific drugs (or drug metabolites) in a given sample. Sometimes, antibodies react with the wrong drug, and when the test shows a reaction occurred, it can be marked as a positive reading for a different drug than intended.

How often false-positives occur in the testing population isn't known, but it certainly is a well-established event that can happen and is discussed in most studies that discuss drug testing.

Final Words

I highly suggest you provide the information I have written about here, along with the study I referenced above, with whoever you need to. This information is publicly available and published in respected academic journals. The links are in the 'references' section at the bottom of this answer.

It is well established that Invega can cause false-positives for fentanyl, and due to the repercussions a positive drug test can have, I would hope you have the opportunity to take another test or have a confirmation test done.

References

  • Invega Manufacturer Website, Janssen
  • Cross-reactivity of acetylfentanyl and risperidone with a fentanyl immunoassay, PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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