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.