iloperidone FANAPT

Class: Second Generation Antipsychotic/​Benzisoxazole
FDA Indications: Schizophrenia
Off-Label Use: Agitation And Aggression In Dementia
Prescribing
Forms: 1, 2, 4, 6, 8, 10, 12mg tablet
Dose Range: 12-24 mg/day
Starting: 1 mg bid; titrate no faster than 2 mg bid (4 mg qd) q24°; recommended dosage range: 6-12 mg bid (maximum: 24 mg/day)
Stopping: Taper 6-8 weeks, rapid d/c can lead to rebound psychosis
Monitoring:

NAMI drug fact sheet

Precautions
Serious Side Effects: , , ,
Possible Risk of TdP, Drugs to Avoid in Congenital Long QT
Side Effects: sedation/somnolence, dizziness, xerostomia, diarrhea, fatigue, tachycardia, orthostatic hypotension, EPS, weight gain (>7%), nasopharyngitis
Pharmacodynamics
1° MOA: 5HT2A–D2 antagonist
Target: Antagonism at: Partial agonist at Postsynaptic 5HT1A
Pharmacokinetics
t½: 18 (24-33)° TMAX: 2-4°
Substrate of: 2D6, 3A4
Inhibits: ∅ ; Induces:
Active Metabolites: P88, P95
DDIs
Misc
  • - very low level of EPS
  • - low level of dyslipidemia
  • - moderate weight gain
  • - high potential for orthostatic hypotension
  • - strong α1 blockade may confer some efficacy in treating traumatic nightmares (similar to prazosin)
Special Populations

Category C—No reports describing the use of iloperidone in human pregnancy have been located. However, there is a risk of extrapyramidal and/ or withdrawal symptoms in the newborn with atypical antipsychotics if they are used in the 3rd trimester.

It is not known if iloperidone is excreted in breast milk. Breast-feeding is not recommended by the manufacturer.

All atypicals may increase mortality in elderly patients by 1.7 times greater than placebo; caution in elderly due to its strong α1 activity and orthostasis and associated fall risk

There are no dosage adjustments required


Mild-moderate impairment: No dosage adjustment necessary. Severe hepatic impairment: Use is not recommended.

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Last updated April 20 2018 09:28:33. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.