Fanapt® (iloperidone)

Brand name: Fanapt®

Generic name: iloperidone (EYE loe PER i done)

Medication class: Second generation antipsychotic (SGA), atypical antipsychotic

All FDA black box warnings are at the end of this fact sheet.  Please review before taking this medication.

What is Fanapt® and what does it treat?

Iloperidone is a medication that works in the brain to treat schizophrenia. It is also known as a second generation antipsychotic (SGA) or atypical antipsychotic. Iloperidone rebalances dopamine and serotonin to improve thinking, mood, and behavior.

Symptoms of schizophrenia include:

Iloperidone may help some or all of these symptoms.

What is the most important information I should know about Fanapt®?

Schizophrenia requires long-term treatment. Do not stop taking iloperidone, even when you feel better.

Only your healthcare provider can determine the length of iloperidone treatment that is right for you.

Missing doses of iloperidone may increase your risk for a relapse in your symptoms.

Do not stop taking iloperidone or change your dose without talking to with your healthcare provider first.

For iloperidone to work properly, it should be taken everyday as ordered by your healthcare provider.

Are there specific concerns about Fanapt® and pregnancy?

If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications. People living with schizophrenia who wish to become pregnant face important decisions. This is a complex decision since untreated schizophrenia has risks to the fetus, as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers.

Caution is advised with breastfeeding since there is currently no information available on whether iloperidone passes into human breast milk. In animal studies iloperidone was excreted in the milk of rats during lactation.

What should I discuss with my healthcare provider before taking Fanapt®?

How should I take Fanapt®?

Iloperidone is usually taken 2 times per day with or without food.

Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.

The dose usually ranges from 6 mg to 12 mg. Only your healthcare provider can determine the correct dose for you.

Use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication.  You may also ask a family member a friend to remind you or check in with you to be sure you are taking your medication.

What happens if I miss a dose of Fanapt®?

If you miss a dose of iloperidone, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your healthcare provider. Do not double your next dose or take more than what is prescribed. If you miss more than 3 days of medication, contact your prescriber because he/she may need to adjust your dose.

What should I avoid while taking Fanapt®?

Avoid drinking alcohol or using illegal drugs while you are taking iloperidone. They may decrease the benefits (e.g. worsen your confusion) and increase adverse effects (e.g. sedation) of the medication.

What happens if I overdose with FANAPT®?

If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.

A specific treatment to reverse the effects of iloperidone does not exist.

What are possible side effects of Fanapt®?

Common Side Effects

Low blood pressure, feeling dizzy or increased heart rate, especially when standing up

Abdominal discomfort, drowsiness, muscle stiffness or spasms

Rare Side Effects

Iloperidone may increase the blood levels of a hormone called prolactin. Side effects of increased prolactin levels include females losing their period, production of breast milk and males losing their sex drive or possibly experiencing erectile problems. Long term (months or years) of elevated prolactin can lead to osteoporosis, or increased risk of bone fractures.

Serious Side Effects

Some people may develop muscle related side effects while taking iloperidone. The technical terms for these are “extrapyramidal effects” (EPS) and “tardive dyskinesia” (TD). Symptoms of EPS include restlessness, tremor, and stiffness. TD symptoms include slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements.

Second generation antipsychotics (SGAs) increase the risk of weight gain, high blood sugar, and high cholesterol. This is also known as metabolic syndrome. Your healthcare provider may ask you for a blood sample to check your cholesterol, blood sugar, and hemoglobin A1c (a measure of blood sugar over time) while you take this medication.

SGAs have been linked with higher risk of death, strokes, and transient ischemic attacks (TIAs) in elderly people with behavior problems due to dementia.

All antipsychotics have been associated with the risk of sudden cardiac death due to an arrhythmia (irregular heart beat). To minimize this risk, antipsychotic medications should be used in the smallest effective dose when the benefits outweigh the risks. Your doctor may order an EKG to monitor for irregular heart beat.

Neuroleptic malignant syndrome is a rare, life threatening adverse effect of antipsychotics which occurs in <1% of patients. Symptoms include confusion, fever, extreme muscle stiffness, and sweating. If any of these symptoms occur, contact your healthcare provider immediately.

Are there any risks of taking Fanapt® for long periods of time?

Tardive dyskinesia (TD) is a side effect that develops with prolonged use of antipsychotics. Medications such as iloperidone have been shown to have a lower risk of TD compared to older antipsychotics, such as Haldol® (haloperidol). If you develop symptoms of TD, such as grimacing, sucking, and smacking of lips, or other movements that you cannot control, contact your healthcare provider immediately. All patients taking either first or second generation antipsychotics should have an Abnormal Involuntary Movement Scale (AIMS) completed regularly by their healthcare provider to monitor for TD.

Second generation antipsychotics (SGAs) increase the risk of diabetes, weight gain, high cholesterol, and high triglycerides. (See “Serious Side Effects” section for monitoring recommendations.)

What other medications may interact with Fanapt®?

Iloperidone may block the effects of agents used to treat Parkinson’s disease such as levodopa/carbidopa (Sinemet®), bromocriptine, pramipexole (Mirapex®), ropinirole (Requip®), and others.

Iloperidone may lower your blood pressure. Medications used to lower blood pressure may increase this effect. Propranolol (Inderal®) is an example of this type of medication.

The following medications may increase the risk of heart problems when used with iloperidone.

The following medications may increase the levels and effects of iloperidone: clarithromycin (Biaxin®), fluoxetine (Prozac®), ketoconazole (Nizoral®), and paroxetine (Paxil®).

Carbamazepine (Tegretol®) may decrease the levels and effects of iloperidone.

How long does it take for Fanapt® to work?

It is very important to tell your doctor how you feel things are going during the first few weeks after you start taking iloperidone. It will probably take several weeks to see big enough changes in your symptoms to decide if iloperidone is the right medication for you.

Antipsychotic treatment is generally needed lifelong for persons with schizophrenia. Your doctor can best discuss the duration of treatment you need based on your symptoms and illness.

Provided by

College of Psychiatric and Neurologic Pharmacists

(January 2013)

Summary of FDA Black Box Warnings

Increased Mortality in Elderly Patients with Dementia Related Psychosis