Home Drug Guide Iloperidone

Drug Guide

Generic Name

Iloperidone

Brand Names Fanapt

Classification

Therapeutic: Antipsychotic

Pharmacological: Atypical antipsychotic

FDA Approved Indications

  • Schizophrenia

Mechanism of Action

Iloperidone works by selectively antagonizing dopamine D2 and serotonin 5-HT2A receptors, helping to balance neurotransmitters related to psychotic symptoms.

Dosage and Administration

Adult: Starting dose is typically 1 mg twice daily, titrated up to 12-24 mg twice daily based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; start at lower doses and monitor closely.

Renal Impairment: Use with caution; adjust dose as needed.

Hepatic Impairment: Use with caution; dose adjustments may be necessary.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Extensively bound to plasma proteins.

Metabolism: Primarily metabolized by CYP3A4 and CYP2D6.

Excretion: Excreted mainly via urine and feces.

Half Life: Approximately 18-25 hours.

Contraindications

  • Hypersensitivity to iloperidone or Component

Precautions

  • History of hypotension, QT prolongation, seizures, misdiagnosis of Parkinson’s disease, or severe cardiac disease.

Adverse Reactions - Common

  • Dizziness (Common)
  • Somnolence (Common)
  • Dry mouth (Common)
  • Weight gain (Common)

Adverse Reactions - Serious

  • QT prolongation (Rare to uncommon)
  • Orthostatic hypotension (Uncommon)
  • Seizures (Rare)
  • Agranulocytosis (Very rare)

Drug-Drug Interactions

  • CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) may increase iloperidone levels. CYP3A4 inducers (e.g., carbamazepine) may decrease levels.

Drug-Food Interactions

  • Avoid grapefruit juice, which inhibits CYP3A4.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, heart rate, and ECG for QT prolongation. Assess mental status and mood.

Diagnoses:

  • Risk of falls due to hypotension or dizziness.
  • Risk of QT prolongation leading to arrhythmias.

Implementation: Administer with food to enhance absorption. Titrate slowly and monitor vital signs.

Evaluation: Effectiveness in reducing psychotic symptoms. Monitor for adverse effects.

Patient/Family Teaching

  • Take medication as prescribed, even if feeling better.
  • Report side effects such as dizziness, fainting, or abnormal heartbeat.
  • Avoid alcohol and other CNS depressants.
  • Learn to recognize signs of cardiac arrhythmias.

Special Considerations

Black Box Warnings:

  • Elderly patients with dementia-related psychosis are at increased risk of death.
  • QT prolongation risk.

Genetic Factors: CYP2D6 poor metabolizers may have higher plasma levels.

Lab Test Interference: May cause false-positive results in some drug screens.

Overdose Management

Signs/Symptoms: Dizziness, hypotension, tachycardia, altered mental status.

Treatment: Supportive care; monitor cardiac status; activated charcoal if early; overcorrection of hypotension with IV fluids and vasopressors as needed.

Storage and Handling

Storage: Store at room temperature away from moisture and heat.

Stability: Stable for the shelf life specified by the manufacturer.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.