Iloperidone
FANAPT
Pronunciation: eye-loe-PER-i-doen
“Fan napped (with) Eye opener”
Antipsychotics are represented with spooky mascots
Polka dots on pink → α1 blocker → syncope if titrated too quickly (hit the floor)
The fan is napping (unplugged), not restless → low akathisia
What it isD2 and 5-HT2A antagonist antipsychotic; schizophrenia and bipolar mania.
Why it mattersAkathisia and extrapyramidal effects are relatively uncommon.
What it changesSlow titration is required because of orthostatic hypotension, making it poor for acute agitation. QT prolongation; CYP2D6-dependent.
Iloperidone prescription history
Animated chart of estimated U.S. prescriptions per year, Bipolar disorder meds (1954–2026). Iloperidone enters in 2010.
FDA-approved for
- schizophrenia (2009)
- bipolar mania (2024)
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Schizophrenia | Adults | 1 mg BID | 6–12 mg BID | 12 mg BID |
| Schizophrenia — CYP2D6 poor metabolizers | Adults | 1 mg BID | 3–6 mg BID | 6 mg BID |
Titration Increase daily per schedule over 7 days to target (to limit orthostatic hypotension)
Renal Undefined
Hepatic Mild (Child-Pugh A): no adjustment; moderate (B): may require dose reduction; severe (C): not recommended
Reinitiate titration if treatment interrupted >3 days
Instructions
- Take orally BID with or without food
- Reduce dose by one-half for CYP2D6 poor metabolizers and with strong CYP2D6 and/or CYP3A4 inhibitors
- If off drug >3 days, reinitiate with the initial titration schedule
Available strengths
- tab 1, 2, 4, 6, 8, 10, 12 mg
Cautions
- QT prolongation — avoid with other QT-prolonging drugs
- Cerebrovascular reactions in elderly with dementia
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- Metabolic changes (hyperglycemia, dyslipidemia, weight gain)
- Orthostatic hypotension/syncope
- Seizures
- Leukopenia/neutropenia/agranulocytosis
- Priapism
- Hyperprolactinemia
Adverse reactions
- Dizziness
- Dry mouth
- Fatigue
- Nasal congestion
- Orthostatic hypotension
- Somnolence
- Tachycardia
- Weight increased
Pregnancy Third-trimester exposure risks extrapyramidal and/or withdrawal symptoms in neonates
Lactation Do not breastfeed during treatment
Cost
| Strength | #/mo | generic $/mo | brand $/mo | CostPlus | |
|---|---|---|---|---|---|
| 1 mg | tab | 60 BID | — | $1,829.91 | not offered |
| 2 mg | tab | 60 BID | — | $1,844.26 | not offered |
| 4 mg | tab | 60 BID | — | $1,831.81 | not offered |
| 6 mg | tab | 60 BID | — | $2,256.86 | not offered |
| 8 mg | tab | 60 BID | — | $2,248.94 | not offered |
| 10 mg | tab | 60 BID | — | $3,617.19 | not offered |
| 12 mg | tab | 60 BID | — | $3,600.60 | not offered |
Generic entry2016
Active metabolites
Open Iloperidone in the interactive console ↗
Memory aids: interaction avatars
Open Iloperidone in the interactive console ↗
Self-check
- Why must iloperidone be titrated slowly?
Orthostatic hypotension. - How common are akathisia and EPS with iloperidone relative to peers?
Relatively uncommon.