Iloperidone Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Schizophrenia

Initial dose: 1 mg orally twice a day
Titration: Increase in increments of not more than 2 mg twice daily as tolerated.
Target dose: 6 to 12 mg twice a day
Maximum dose: 24 mg/day

Comments:
-This drug must be titrated slowly to avoid orthostatic hypotension; because of the need to titrate slowly, control of symptoms may be delayed during the first 1 to 2 weeks of treatment.

Use: Treatment of schizophrenia

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Mild hepatic impairment: No adjustment recommended.
Moderate hepatic impairment: Use with caution.
Sever hepatic impairment: Not recommended.

Dose Adjustments

-Reduce iloperidone dose by one-half in CYP450 2D6 poor metabolizers.

Concomitant use with CYP450 2D6 Inhibitors:
-Reduce iloperidone dose by one-half when administered with CYP450 2D6 inhibitors such as fluoxetine or paroxetine.
-When CYP450 3A4 inhibitors such as fluoxetine or paroxetine is stopped, may increase iloperidone dose to where it was before.

Concomitant use with strong CYP450 3A4 Inhibitors:
-Reduce iloperidone dose by one-half when administered with strong CYP450 3A4 inhibitors such as ketoconazole or clarithromycin.
-When strong CYP450 3A4 inhibitors such as ketoconazole or clarithromycin is stopped, may increase iloperidone dose to where it was before.

Precautions

US BOXED WARNING:
Increased Mortality in Elderly Patients with Dementia-Related Psychosis
-Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.
-Iloperidone is not approved for the treatment of patients with dementia-related psychosis.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration Advice:
-Oral: May take with or without food

Storage requirements:
-Protect from light

General:
-Prior to prescribing iloperidone, physician should take into account need for dose titration and therefore delay in symptom control, and QT interval prolongation risk.
-For patients reinitiating treatment after an off interval of more than 3 days, follow the initial titration schedule.
-Controlled clinical trials assessing long-term use are not available; the physician who prescribes iloperidone should periodically re-evaluate the long-term risks and benefits of the drug for the individual patient.
-No specific recommendations are available regarding switching from other antipsychotics or for the use of concomitant antipsychotics.

Monitoring:
-Cardiovascular: Orthostatic vital signs in at-risk patients
-Hematologic: CBC frequently during the first few months in patients with preexisting low WBC and/or a prior history of drug-induced leukopenia or neutropenia.
-Metabolic:Increases in blood sugar, weight, and lipids

Patient Advice:
-Inform patient that this drug may cause dizziness upon arising; it is best to get up slowly form a seated or lying position.
-This drug may impair judgment, thinking, or motor skills; have patient avoid driving or operating machinery until adverse effects are determined.
-Advise patient to speak to physician or health care professional if pregnant, intend to become pregnant, or are breastfeeding.
-Advise patient that this drug may cause metabolic changes such as increases in blood sugar, body weight and lipids.
-Patients should avoid overheating and dehydration.

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