Iloperidone
Generic: iloperidone · Brand: Fanapt® · Class: 2nd Gen Antipsychotic
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How It Works
Iloperidone is a second-generation (atypical) antipsychotic that blocks dopamine D2 and serotonin 5-HT2A receptors, similar to other atypicals. It also blocks norepinephrine receptors, which contributes to its side effect profile including dizziness and low blood pressure. A key feature of iloperidone is that it must be titrated very slowly over 1–2 weeks to minimize orthostatic hypotension (dizziness when standing). It also prolongs the QT interval, requiring cardiac monitoring. It is metabolized differently based on CYP2D6 enzyme status, meaning some patients need lower doses.
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What It Treats
SchizophreniaFDA-approved for adults — effective for both positive symptoms (hallucinations, delusions) and negative symptoms (flat affect, withdrawal)
Treatment-Resistant CasesSometimes used when other antipsychotics have not been well tolerated due to movement side effects
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Dosing Overview
| Population | Start | Typical Range | Max |
|---|---|---|---|
| Adults Schizophrenia | 1 mg twice daily | 6–12 mg twice daily | 24 mg/day |
| Poor CYP2D6 metabolizers Reduce dose by half | 1 mg twice daily | 3–6 mg twice daily | 12 mg/day |
| With CYP2D6 inhibitors Reduce dose by half | 1 mg twice daily | 3–6 mg twice daily | 12 mg/day |
Taken twice daily with or without food. Must be titrated slowly over 1–2 weeks — do not skip the titration. An EKG before starting is recommended. Doses must be reduced if taking CYP2D6 inhibitors.
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Side Effects
Common
- Dizziness (most common)
- Dry mouth
- Fatigue
- Nasal congestion
- Weight gain
- Increased heart rate
- QT prolongation
- Orthostatic hypotension
Call us if you notice
- Tardive dyskinesia (involuntary movements)
- Neuroleptic malignant syndrome (NMS)
- Significant weight gain
- High blood sugar or new diabetes
- Severe restlessness (akathisia)
- Muscle stiffness or rigidity
- QT prolongation / cardiac arrhythmia
- Severe orthostatic hypotension (fainting
Dizziness and low blood pressure when standing are the most common complaints, especially early in treatment. The slow titration schedule is essential — do not rush dose increases. Rise slowly from sitting or lying positions.
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Tips for Success
Same Time DailyTake at the same time each day for consistent levels in your system.
With FoodTaking with food reduces nausea and stomach upset.
Don't Stop AbruptlyAlways taper with your provider guidance — stopping suddenly can cause rebound symptoms.
Avoid AlcoholAlcohol increases sedation and side effects significantly.
Tell All ProvidersLet other prescribers know what you are taking — interactions matter.
Track Your MoodNote any changes in mood, movement, or weight and share with your provider.
Rise SlowlyStand up slowly from sitting or lying — iloperidone lowers blood pressure and can cause fainting if you move too quickly.
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Important Safety Information
Tardive Dyskinesia: Long-term use can cause involuntary repetitive movements of the face, tongue, or limbs. Report any unusual movements to your provider immediately.
Elderly Patients with Dementia: Antipsychotics carry a black box warning for increased risk of death in elderly patients with dementia-related psychosis. Not approved for this use.
Metabolic Effects: Many antipsychotics can cause weight gain, elevated blood sugar, and increased cholesterol. Your provider will monitor these regularly.
Pregnancy & Breastfeeding: Discuss risks and benefits with your provider. Do not stop without consultation.
Drug Interactions: Antipsychotics interact with many medications. Always share your full medication list.
QT Prolongation: Iloperidone prolongs the QT interval and should be avoided with other QT-prolonging medications. An EKG is recommended before starting.
CYP2D6 Interactions: Medications that inhibit CYP2D6 (such as fluoxetine, paroxetine, or bupropion) can double iloperidone levels. Your provider will adjust your dose accordingly.
Questions? I am here.
Reach me between appointments if you have concerns about side effects, notice mood changes, or have questions about your medication.
360-389-3712
info@rootedmindspsychiatry.com