Indications
Iloperidone is an antipsychotic medicine used to treat schizophrenia in adults, a mental illness that can cause hallucinations (hearing or seeing things that are not there), fixed false beliefs, disorganised thinking and withdrawal. In some countries it is also used for manic or mixed episodes of bipolar I disorder.
How It Works
Iloperidone is an atypical (second-generation) antipsychotic. It blocks dopamine D2 and serotonin 5-HT2A receptors in the brain, helping to rebalance these chemical messengers and reduce psychotic symptoms. It also blocks alpha-1 receptors, which explains its tendency to lower blood pressure.
Dosage and Administration
Iloperidone must be started at a low dose and increased gradually over about a week to reduce dizziness and fainting, according to the doctor’s schedule. It is taken twice daily, with or without food, as prescribed. If you miss doses for more than 3 days, do not restart at your usual dose; contact your doctor, as the dose may need to be built up again.
- Do not stop suddenly without medical advice.
- Effects on symptoms may take a few weeks to become clear.
Interactions
Strong CYP2D6 inhibitors (such as Fluoxetine, Paroxetine) and strong CYP3A4 inhibitors (such as Ketoconazole, Clarithromycin) raise its levels, and the dose usually needs to be halved. Other medicines that prolong the QT interval, such as some antiarrhythmics (Amiodarone, Sotalol), Haloperidol, Citalopram, Methadone and certain antibiotics, increase the risk of dangerous heart rhythms. Blood pressure medicines may add to dizziness. Alcohol and sedatives increase drowsiness.
Contraindications
- Allergy to Iloperidone or any ingredient.
- Use with care, or avoid, in people with long QT syndrome, recent heart attack, uncontrolled heart failure or serious heart rhythm problems.
Side Effects
Common side effects include dizziness, especially on standing, drowsiness, dry mouth, stuffy nose, fast heartbeat, weight gain, tiredness and nausea. Ejaculation problems and, rarely, a painful prolonged erection (priapism) can occur. Raised blood sugar, cholesterol and prolactin, and movement problems are possible.
Get urgent medical help if you faint, have a fast or irregular heartbeat, high fever with stiff muscles, sweating and confusion (neuroleptic malignant syndrome), uncontrollable movements of the face or body, an erection lasting more than 4 hours, seizures, or thoughts of harming yourself.
Pregnancy and Lactation
Use during pregnancy only if the doctor decides the benefit outweighs the risk; babies exposed in the last trimester may have movement problems or withdrawal symptoms after birth. Do not stop treatment on your own if you become pregnant; talk to your doctor. Breastfeeding is not recommended during treatment.
Precautions and Warnings
Older people with dementia-related psychosis treated with antipsychotics have an increased risk of death, and this medicine is not approved for that use. Use with care in heart disease, low blood pressure, dehydration, diabetes, seizures, liver disease and in older people. Weight, blood sugar and blood lipids should be checked regularly. Avoid driving until you know how it affects you, and avoid overheating and dehydration.
Overdose
Overdose may cause severe drowsiness, low blood pressure, fast heartbeat, QT prolongation and abnormal heart rhythms, and movement problems. Seek emergency medical help immediately; heart monitoring and supportive care are needed.
Therapeutic Class
Atypical (second-generation) antipsychotic.
Storage
Store below 30°C in a dry place, away from light and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.