Trade Names:Fanapt- Tablets 1 mg- Tablets 2 mg- Tablets 4 mg- Tablets 6 mg- Tablets 8 mg- Tablets 10 mg- Tablets 12 mg- Tablets, Titration Pack contains two 1 mg, two 2 mg, two 4 mg, and two 6 mg tablets (total of 8 tablets)
Has antipsychotic effect; exact mechanism of action is unknown. Proposed efficacy caused by dopamine type 2 and serotonin type 2 antagonisms.
Relative bioavailability is 96% compared with oral solution. T max is 2 to 4 h. Steady state within 3 to 4 days.
Vd is 1,340 to 2,800 L. Protein binding is about 95%.
Primarily metabolized in the liver by carbonyl reduction, CYP2D6 and CYP3A4 to metabolites P95 and P88.
Elimination mainly through hepatic metabolism by CYP2D6 and CYP3A4. Mean elimination half-lives for iloperidone, P88, and P95 in CYP2D6 extensive metabolizers are 18, 26, and 23 h, respectively, and in poor metabolizers are 33, 37, and 31 h, respectively.
Unlikely to have impact on the pharmacokinetics.Hepatic Function Impairment
Not recommend for patients with hepatic impairmentElderly
No dosage adjustment recommended.Gender
No dosage adjustment recommended.Race
No dosage adjustment recommended.
Acute treatment of adults with schizophrenia.
PO Starting dose is 1 mg twice daily. Increases to reach target dose range of 6 to 12 mg twice daily may be made with adjustments to 2 mg twice daily, 4 mg twice daily, 6 mg twice daily, 8 mg twice daily, 10 mg twice daily, and 12 mg twice daily on days 2, 3, 4, 5, 6, and 7, respectively. Max is 12 mg twice daily (24 mg/day). Efficacy was demonstrated with a dosage range of 6 to 12 mg twice daily. Effectiveness for more than 6 wk has not been evaluated.Dosage adjustments CYP2D6 and CYP3A4 inhibitors
Reduce dose by 50% when administered with CYP2D6 and CYP3A4 inhibitors. When inhibitor is withdrawn, dose may be increased.CYP2D6 poor metabolizers
Consider dosing adjustment in poor metabolizers of CYP2D6.
Store tablets between 59° and 86° F. Protect from light and moisture.
May cause additive CNS depressant effects.Antihypertensives
May enhance hypotensive effects of some antihypertensives.CYP2D6 inhibitors (eg, fluoxetine, paroxetine)
May increase iloperidone plasma concentrations. During coadministration, reduce iloperidone dose by 50%.CYP3A4 inhibitors (eg, clarithromycin, ketoconazole)
May increase iloperidone plasma concentrations. During coadministration, reduce iloperidone dose by 50%.QT interval–prolonging drugs (eg, bretylium, disopyramide, procainamide, quinidine)
The additive effect of iloperidone with other drugs that prolong the QT interval cannot be excluded.
None well documented.
Tachycardia (12%); orthostatic hypotension (5%); hypotension (3%); palpitations (at least 1%).
Dizziness (20%); somnolence (15%); fatigue (6%); extrapyramidal disorder (5%); lethargy, tremor (3%); akathisia, dyskinesia, dystonia (2%).
Dry mouth, nausea (10%); diarrhea (7%); abdominal discomfort (3%).
Ejaculation failure (2%); erectile dysfunction, urinary incontinence (at least 1%).
Weight increased (9%); weight decreased (at least 1%).
Arthralgia, musculoskeletal stiffness (3%); muscle spasms, myalgia (at least 1%).
Vision blurred (3%); conjunctivitis (including allergic) (at least 1%).
Nasal congestion (8%); nasopharyngitis (4%); upper respiratory tract infection (3%); dyspnea (2%).
Rash (3%); hematocrit low (1%).
WarningsIncreased mortality in elderly patients with dementia-related psychosis
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. During the course of a typical 10-week trail, the rate of death in drug-treated patients was about 4.5% compared with a rate of about 2.6% in the placebo group. Although the causes of death varied, most of the deaths appeared to be CV (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature.
Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. Iloperidone is not approved for the treatment of patients with dementia-related psychosis.
Monitor serum potassium and magnesium in patients at risk for electrolyte disturbances.
Monitor orthostatic vital signs in patients who are vulnerable to hypotension.
Monitor patients for symptoms of hyperglycemia.
Monitor CBC in patients with preexisting low WBC or a history of drug-induced leukopenia/neutropenia, and discontinue iloperidone at first sign of decline of WBC in the absence of other causative factors.
Category C .
Safety and effectiveness in children have not been established.
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death compared with placebo.
Iloperidone is not recommended for patients with hepatic impairment.
Disruption of the body's ability to reduce core body temperature has been attributed to antipsychotic agents.
In placebo-controlled trials with risperidone, aripiprazole, and olanzapine in elderly patients with dementia, there was a higher incidence of cerebrovascular adverse reactions, including fatalities compared with placebo-treated patients.
Hypokalemia and/or hypomagnesemia may increase risk of QT prolongation.
Iloperidone can induce orthostatic hypotension associated with dizziness, tachycardia, and syncope.
Iloperidone is associated with prolongation of the QTc interval. Avoid use of iloperidone in combination with other drugs that are known to prolong QTc interval.
Judgment, thinking, or motor skills may be impaired.
Esophageal dysmotility and aspiration have been associated with antipsychotic drugs. Use iloperidone cautiously in patients at risk for aspiration pneumonia.
In clinical trials and postmarketing experience, events of leukopenia/neutropenia and agranulocytosis have been reported.
Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics, including iloperidone.
Iloperidone elevates prolactin levels.
Has been reported in association with administration of antipsychotic drugs. Clinical manifestations may include hyperpyrexia, muscle rigidity, altered mental status, evidence of autonomic instability, elevated creatine phosphokinase, myoglobinuria, and acute renal failure. Immediately discontinue antipsychotic drug if NMS is diagnosed.
Drugs with alpha-adrenergic properties have been reported to cause priapism. Iloperidone shares this pharmacologic activity and 3 cases were reported in the premarketing iloperidone program.
As with other antipsychotics, use iloperidone with caution in patients with a history of seizures or with conditions that potentially lower seizure threshold.
Possible suicide attempts are inherent in psychotic illness. Closely supervise high-risk patients. Prescribe the smallest quantity consistent with good patient management.
Tardive dyskinesia may develop in patients treated with antipsychotic drugs. Prevalence appears to be highest among elderly patients, especially elderly women. The risk of developing tardive dyskinesia and the likelihood that it will become irreversible are believed to increase as the duration of treatment and total cumulative dose of antipsychotic administered increase.
Weight gain of 7% or more of body weight was 13% for iloperidone patients versus 4% for placebo patients.
Reported signs and symptoms resulted from an exaggeration of the known pharmacological effects (eg, drowsiness and sedation, QT prolongation, tachycardia and hypotension) of iloperidone.
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