It is an atypical antipsychotic agent indicated for the acute treatment of schizophrenia in adults . In choosing among treatments,prescribers should consider the ability of it to prolong the QT interval and the use of other drugs first. Prescribers should also consider the need to titrate it slowly to avoid orthostatic hypotension,which may lead to delayed effectiveness compared to some other drugs that do not require similar titration.
Iloperidone shows high affinity and maximal receptor occupancy for dopamine D2 receptors in the caudate nucleus and putamen of the brains of schizophrenic patients. The improvement in cognition is attributed to iloperidone's high affinity for α adrenergic receptors. Iloperidone also binds with high affinity to serotonin 5-HT2a and dopamine 3 receptors. Iloperidone binds with moderate affinity to dopamine D4, serotonin 5-HT6 and 5-HT7, and norepinephrine NEα1 receptors. Furthermore, iloperidone binds with weak affinity to serotonin 5-HT1A, dopamine D1, and histamine H1 receptors.
The recommended target dosage of tablets is 12 to 24 mg/day administered twice daily. This target dosage range is achieved by daily dosage adjustments,alerting patients to symptoms of orthostatic hypotension,starting at a dose of 1 mg twice daily,then moving to 2 mg,4 mg,6 mg,8 mg,10 mg,and 12 mg twice daily on days 2,3,4,5,6,and 7 respectively,to reach the 12 mg/day to 24 mg/day dose range. FANAPT can be administered without regard to meals.
There are no known drug interactions and none well documented.
Known hypersensitivity to it or to any components in the formulation. ? Elderly patients with dementia-related psychosis who are treated with atypical antipsychotic drugs are at an increased risk of death and cerebrovascular-related adverse events,including stroke. ? QT prolongation: Prolongs QT interval and may be associated with arrhythmia and sudden death?consider using other antipsychotics first. Avoid use of it in combination with other drugs that are known to prolong QTc; use caution and consider dose modification when prescribing it with other drugs that inhibit metabolism. Monitor serum potassium and magnesium in patients at risk for electrolyte disturbances ? Neuroleptic Malignant Syndrome: Manage with immediate discontinuation of drug and close monitoring. ? Tardive dyskinesia: Discontinue if clinically appropriate. ? Hyperglycemia and diabetes mellitus: Monitor glucose regularly in patients at risk for diabetes. ? Seizures: Use cautiously in patients with a history of seizures or with conditions that lower seizure threshold. ? Orthostatic hypotension: Dizziness,tachycardia,and syncope can occur with standing. ? Leukopenia,Neutropenia,and Agranulocytosis have been reported with antipsychotics. Patients with a pre-existing low white blood cell count (WBC) or a history of leukopenia/neutropenia should have their complete blood count (CBC) monitored frequently during the first few months of therapy and should discontinue it at the first sign of a decline in WBC in the absence of other causative factors. ? Suicide: Close supervision of high risk patients. ? Priapism: Cases have been reported in association with its treatment. ? Potential for cognitive and motor impairment: Use caution when operating machinery. ?
dizziness,dry mouth,fatigue,nasal congestion,orthostatic hypotension,somnolence,tachycardia,and weight increased
Pregnancy: No human or animal data. Use only if clearly needed. ? Nursing Mothers: Should not breast feed.
In pre-marketing trials involving over 3,522 patients, accidental or intentional overdose of FANAPT was
documented in 8 patients ranging from 48 mg to 576 mg taken at once and 292 mg taken over a 3-day period.
No fatalities were reported from these cases. The largest confirmed single ingestion of FANAPT was 576 mg;
no adverse physical effects were noted for this patient. The next largest confirmed ingestion of FANAPT was 438 mg over a 4-day period; extrapyramidal symptoms and a QTc interval of 507 msec were reported for this
patient with no cardiac sequelae. This patient resumed FANAPT treatment for an additional 11 months. In
general, reported signs and symptoms were those resulting from an exaggeration of the known pharmacological
effects (e.g., drowsiness and sedation, tachycardia, and hypotension) of FANAPT.
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