iloperidone (Fanapt): Schizophrenia Drug Side Effects & Dosage

What is iloperidone? What are the side effects of iloperidone?

Iloperidone is an oral, atypical antipsychotic used to treat schizophrenia. Other atypical antipsychotic drugs
include

olanzapine (Zyprexa),
quetiapine (Seroquel),
ziprasidone (Geodon), and
aripiprazole (Abilify).

Atypical antipsychotics differ from typical antipsychotics because they cause
a lesser degree of movement (extrapyramidal) side effects and constipation.

The exact mechanism of action of iloperidone is not known, but like other
anti-psychotics, it is believed that iloperidone affects the way the brain works
by interfering with communication among the brain's nerves. Nerves communicate
with each other by making and releasing chemicals called neurotransmitters. The
neurotransmitters travel to other nearby nerves where they attach to receptors
on the nerves. The attachment of the neurotransmitters either stimulates or
inhibits the function of the nearby nerves. iloperidone blocks several of the
receptors on nerves including dopamine type 2, serotonin type 2, and alpha 2
adrenergic receptors. It is believed that many psychotic illnesses are caused by
abnormal communication among nerves in the brain and that by altering
communication through neurotransmitters, iloperidone can alter the psychotic
state. Iloperidone was approved by the FDA in 2009.

What brand names are available for iloperidone?

Fanapt

Is iloperidone available as a generic drug?

Do I need a prescription for iloperidone?

Yes

What are the side effects of iloperidone?

The most common side effects include

dizziness,
dry mouth,
fatigue,
nasal congestion,
orthostatic hypotension,
somnolence,
tachycardia, and
weight gain.

Less common but serious side effects include:

Increased risk of stroke in elderly patients with dementia-related psychosis.
Neuroleptic malignant syndrome (NMS). NMS is a rare but serious side effects
associated with the use of antipsychotics. NMS may result in death and must be
treated in the hospital.
- Signs and symptoms of NMS may include high
  fever,
  sweating (diaphoresis), severe muscle stiffness or rigidity,
  confusion, loss of
  consciousness,
  high blood pressure, rapid heartbeat, and changes in
  breathing.

Extrapyramidal side effects (EPS) including:

Dystonia: painful spasms of the oral, throat, or neck muscles that may cause
problems with speech, swallowing, and stiff neck.
Akathisia: feelings of restlessness or difficulty sitting still.
Pseudoparkinsonism: drug induced Parkinson’s symptoms.
Tardive dyskinesia (TD). TD usually occurs after long term use of
antipsychotics and usually presents with movement problems affecting the tongue,
lips, jaw, face, and extremities.
Metabolic changes including high blood sugar (hyperglycemia),
diabetes
mellitus, increase in blood cholesterol, and weight gain.
High blood levels of prolactin. Prolactin is a hormone that allows the
production of breast milk. High levels of prolactin may cause menstrual
abnormalities, leakage of milk from the breast, development of breasts in males,
and erection problems in men.
Seizures may occur.
Iloperidone causes sedation and slows thinking and movement. Patients should
avoid potentially dangerous activities such as driving and operating machinery
until they are certain that iloperidone does not impair their ability to perform
such tasks.

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Schizophrenia is the most disabling mental illness.
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What is the dosage for iloperidone?

The recommended target dose is 12 to 24 mg/day in two divided doses.
TThe starting dose is 1 mg twice daily, then 2 mg on day 2, 4 mg on day 3, 6
mg on day 4, 8 mg on day 5, 10 mg on day 6, and 12 mg on day 7.
Doses are given twice daily.
Iloperidone may be administered without regard
to meals.

Which drugs or supplements interact with iloperidone?

Iloperidone can reduce blood pressure especially when standing up from a
sitting or lying down position (orthostatic hypotension). Therefore, iloperidone
should be used cautiously with other drugs also associated with orthostatic
hypotension.

Iloperidone is broken down by enzymes in the liver. Drugs that block the
action of these enzymes increase blood levels of iloperidone. Ketoconazole,
fluoxetine (Prozac), and paroxetine (Paxil) increase blood levels of iloperidone
through this mechanism.

The risk of abnormal heartbeats increases when iloperidone is combined with
other drugs that cause abnormal heartbeats.

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Is iloperidone safe to take if I’m pregnant or breastfeeding?

Currently there is no data on the use of iloperidone
during pregnancy. Iloperidone should only be used during pregnancy if the potential
benefit to the mother outweighs the potential for side effects in the fetus.

Fetuses exposed to antipsychotics during the third trimester of pregnancy are
at risk for extrapyramidal and withdrawal symptoms after birth. Symptoms
reported included agitation, hypertonia, hypotonia, tremor, somnolence,
depressed breathing, and feeding disorder.

A pregnancy exposure registry has been established to monitor the use of
atypical antipsychotics, including iloperidone, during pregnancy. All
pregnant
women treated with atypical antipsychotics are advised to enroll in this
pregnancy registry and report any side effects.

Iloperidone has not been evaluated in
nursing mothers.

What else should I know about iloperidone?

What preparations of iloperidone are available?

How should I keep iloperidone stored?

Iloperidone should be stored at room temperature between 15 C and 30
C (59 F and 86 F).