Iloperidone ($ Fanapt)
Second generation antipsychotic (serotonine, dopamine receptor antagonist (D2, 5-HT2))
- Schizophrenia
- Mania/mixed
Features
Dosing
Start 2mg 1/2 bid x1day, 1 bid x1day, 2 bid x 1day then 3 bid.
Management
FDA approved only for schizophrenia and mania. Weight gain is about twice that of aripiprazole and lurisidone, but half that of olanzapine/quetiapine. Lower risk of akathisia.
TOLERABILITY: Weight gain, sedation, akathisia, EPS (dystonia, stiffness), anticholinergic.
RISKS: Tardive dyskinesia (25% over 10 years, higher in elderly), metabolic, prolactinemia (can lead to breast cancer, osteopenia, sexual dysfunction), orthostasis (falls), QTc prolongation, temperature imbalance in elderly, NMS (muscle rigidity, fever, tachycardia).
EMR Text
Bipolar mania/mixed
Iloperidone use based on FDA approval in bipolar disorder.
Antipsychotic side effects, including metabolic, prolactinemia, and TD, reviewed with patient.
Schizophrenia
Iloperidone use based on FDA approval in schizophrenia.
Antipsychotic side effects, including metabolic, prolactinemia, and TD, reviewed with patient.