Fanapt
Iloperidone (Fanapt) is an atypical antipsychotic. Brand name Fanapt is FDA-approved for schizophrenia and bipolar disorder in adults. Generic iloperidone is currently only approved for schizophrenia. Iloperidone (Fanapt) comes as a tablet that's taken by mouth twice per day. Don't drink alcohol while taking iloperidone (Fanapt) because doing so can worsen some common side effects, like sleepiness and dizziness. Some people have reported weight gain while taking this medication.
What is Iloperidone (Fanapt)?
What is Iloperidone (Fanapt) used for?
Schizophrenia in adults
Manic or mixed episodes of bipolar I disorder in adults (brand name Fanapt only)
How Iloperidone (Fanapt) works
Iloperidone (Fanapt) is an atypical antipsychotic. It's not completely known how iloperidone (Fanapt) works. But it's thought to work by balancing out the levels of chemicals (dopamine and serotonin) in your brain to help manage your thoughts, mood, and behaviors.
Drug Facts
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What are the side effects of Iloperidone (Fanapt)?
Common Side Effects
- Dizziness (up to 20%)
- Sleepiness (up to 15%)
- Fast heart rate (up to 12%)
- Dry mouth (up to 10%)
- Nausea (up to 10%)
- Fast heart rate (up to 23%)
- Dizziness (up to 12%)
Other Side Effects
- Weight gain
- Stuffy nose
- Diarrhea
- Dizziness when standing too quickly (orthostatic hypotension)
- Weakness
Serious Side Effects
- Neuroleptic malignant syndrome: fever, sweating, stiff muscles, confusion, not aware of your surroundings, fast or irregular heartbeat
- Stroke: numbness or weakness typically on one side of the body, loss of balance, headache, blurred vision, difficulty speaking
- Dangerously high blood sugar: frequently thirsty, needing to urinate often, tiredness, nausea, vomiting, difficulty breathing, having fruity breath, having dry mouth
- Serious infections: fever, headache, chills, body aches, cough, weakness
- Seizures
- Difficulty swallowing
Source: DailyMed
More on Iloperidone (Fanapt) side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Fast, pounding, or irregular heartbeat or pulse
Less common
Blurred vision
body aches or pain
chills
cold sweats
confusion
difficult or labored breathing
difficulty with moving
difficulty with speaking
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
ear congestion
headache
inability to sit still
loss of balance control
loss of voice
muscle pain or stiffness
muscle trembling, jerking, or stiffness
need to keep moving
pain in the joints
restlessness
shakiness in the legs, arms, hands, or feet
shortness of breath
shuffling walk
stiffness of the limbs
sweating
tightness in the chest
trembling or shaking of the hands or feet
twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
uncontrolled movements, especially of the face, neck, and back
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
Rare
Abdominal or stomach fullness
aching or discomfort in the lower legs or sensation of crawling in the legs
actions that are out of control
aggressive or angry
agitation
attack, assault, or force
back pain
black, tarry stools
bloody nose
burning while urinating
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
chest pain or discomfort
coma
confusion as to time, place, or person
convulsions
decrease in the amount of urine
decrease in the frequency of urination
decrease in urine volume
decreased awareness or responsiveness
decreased urination
decreased weight
difficult or painful urination
difficulty in passing urine (dribbling)
difficulty with walking
dilated neck veins
dizziness
dry skin and hair
extreme thirst
extremely high fever or body temperature
fainting
false beliefs that cannot be changed by facts
fast, shallow breathing
feeling cold
gaseous abdominal pain
groin pain
hoarseness or husky voice
holding false beliefs that cannot be changed by fact
hostility
inability to move the eyes
increased blinking or spasms of the eyelid
increased thirst
irregular breathing
irritability
lightheadedness
loss of appetite
loss of bladder control
mimicry of speech or movements
mood swings
muscle aching or cramping
muscle twitching
nausea or vomiting
nervousness
noisy breathing
noisy, rattling breathing
numbness or tingling in the hands, feet, or lips
pale, clammy skin
peculiar postures or movements, mannerisms, or grimacing
pounding, slow heartbeat
rapid breathing
rapid weight gain
recurrent fever
restlessness
seizures
severe sleepiness
slow movement
slow reflexes
sore tongue
sores, ulcers, or white spots on the lips or in the mouth
sticking out of tongue
stupor
sunken eyes
swelling
swelling of the face, ankles, fingers, feet, or lower legs
swollen glands
swollen joints
swollen, tender prostate
talking, feeling, and acting with excitement
thirst
troubled breathing at rest
troubled breathing with exertion
uncontrolled twisting movements of the neck, trunk, arms, or legs
unusual bleeding or bruising
unusual excitement, nervousness, or restlessness
unusual facial expressions
wrinkled skin
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Rare
Absent, missed, or irregular menstrual periods
blindness
blurred vision
breast pain
burning feeling in the chest or stomach
burning upper abdominal pain
continuing ringing or buzzing or other unexplained noise in the ears
decreased interest in sexual intercourse
decreased vision
delusions of persecution, mistrust, suspiciousness, or combativeness
feeling of constant movement of self or surroundings
hearing loss
inability to have or keep an erection
increase in blood flow to the whites of the eyes
increased appetite
increased watering of the mouth
indigestion
irritation or soreness of the mouth
longer or heavier menstrual periods
loss in sexual ability, desire, drive, or performance
loss of bowel control
loss of memory
normal menstrual bleeding occurring earlier, possibly lasting longer than expected
problems with memory
redness, swelling, or itching of the eyelids
sensation of spinning
stomach upset
stopping of menstrual bleeding
swelling of the breasts or breast soreness in both females and males
swelling or inflammation of the mouth
tenderness in the stomach area
uncontrolled eye movements
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Iloperidone (Fanapt)
Pros
Taken by mouth
Comes in many different strengths to make it easier to customize your dose
A starter pack is available for when you first start to help you figure out your dose.
Available as a lower-cost generic
Cons
Taken twice a day
Hasn't been studied in children
The dose needs to be slowly raised
Safety in pregnancy and breastfeeding isn't well-understood
Pharmacist tips for Iloperidone (Fanapt)
You can take iloperidone (Fanapt) with or without food. But nausea is a common side effect, so taking it with food might help.
Don't change your dose or suddenly stop taking iloperidone (Fanapt) without talking to your prescriber first. Doing so can cause withdrawal symptoms, such as nausea, vomiting, and dizziness. If you're interested in stopping the medication, contact your healthcare professional (HCP). They can help you do so safely by lowering your dose slowly over time.
Iloperidone (Fanapt) can make you sleepy and dizzy, or it can make it difficult to sleep. Don't drive or do anything requiring concentration until you know how this medication affects you. Also, avoid alcohol because it can worsen sleepiness and dizziness.
Iloperidone (Fanapt) can raise your blood sugar levels. If you have diabetes, ask your diabetes care team if you need to check your blood sugar more often while taking iloperidone (Fanapt).
Iloperidone (Fanapt) can raise cholesterol (fat) levels in your blood and can cause weight gain. It's important that you eat a healthy and balanced diet low in fat and sugar and maintain a regular exercise routine while taking iloperidone (Fanapt).
Iloperidone (Fanapt) can cause a drop in blood pressure when moving positions, such as from sitting to standing (called orthostatic hypotension). Because of this risk, your prescriber will start you off on a low dose and then slowly raise it. Make sure to get up slowly and try to hold onto something for stability. If you end up falling or hitting your head, get medical help right away.
Although rare, iloperidone (Fanapt) can cause difficulty swallowing, which can raise the risk for choking. Make sure to take small bites of food and eat slowly to lower your risk for choking.
Iloperidone (Fanapt) can make it harder for your body to cool down if your body temperature gets too high. This makes it more likely for you to become dehydrated and your body to overheat. Let your HCP know if you feel very hot or thirsty, notice a change in the amount of sweat or urine you make, or if you notice very dark-colored urine.
Iloperidone (Fanapt) interacts with a lot of commonly used medications, such as certain selective serotonin reuptake inhibitor (SSRIs) and ketoconazole. Let your care team know about all the medications you're taking before and during treatment with iloperidone (Fanapt).
Frequently asked questions about Iloperidone (Fanapt)
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What are the risks and warnings for Iloperidone (Fanapt)?
Iloperidone (Fanapt) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Higher risk of death in older people with dementia-related psychosis
Risk factors: Age 65 years and older with dementia and psychosis
People ages 65 years and older with dementia sometimes have symptoms of schizophrenia, like delusions and hallucinations (believing, seeing, or hearing things that aren't real). This is called dementia-related psychosis. Older people with dementia-related psychosis have a high risk of death if they take medications like iloperidone (Fanapt). The causes of death are often related to heart failure, stroke, or infection. Because of this risk, iloperidone (Fanapt) shouldn't be used in people 65 years and older with dementia-related psychosis. Let your prescriber know if you or your loved one has dementia before starting iloperidone (Fanapt).
Life-threatening abnormal heart rhythm (QT prolongation)
Risk factors: Low blood potassium or magnesium levels | History of heart problems, slow heart rate, or other abnormal heart rhythms (arrhythmias) | Older age | Personal or family history of long QT syndrome | Taking other medications that cause QT prolongation
Iloperidone (Fanapt) can affect your heart rhythm, which can be serious and life-threatening. One example includes affecting the time it takes for your heart to pump and then relax. This is known as QT prolongation. Your risk for QT prolongation is higher if you have certain factors, including abnormal electrolyte levels, heart rhythm problems, or are taking other medications that cause heart rhythm problems, such as amiodarone (Pacerone), among others. If you feel your chest pounding, have shortness of breath or chest pain, or feel faint or lightheaded while taking iloperidone (Fanapt), call 911 right away.
Neuroleptic malignant syndrome
Taking antipsychotic medications like iloperidone (Fanapt) can cause a rare, but life-threatening condition called neuroleptic malignant syndrome. Symptoms include fever, sweating, stiff muscles, confusion, not aware of your surroundings, and fast or irregular heartbeat. If you experience any of these symptoms while taking iloperidone (Fanapt), get medication attention as soon as possible. Your prescriber will likely have you stop taking iloperidone (Fanapt) and switch you to something else.
Weight gain, higher blood sugar, and higher cholesterol levels
Risk factors: Diabetes | High cholesterol | Obesity
Iloperidone (Fanapt) can raise your blood sugar and cholesterol levels as well as raise your appetite, all of which can lead to weight gain. Your prescriber will likely order blood tests regularly throughout treatment with iloperidone (Fanapt) to make sure your blood sugar and cholesterol aren't too high. Work with your prescriber to come up with a plan for a healthy and balanced diet low in fat and sugar and maintain a regular exercise routine while taking iloperidone (Fanapt).
Difficulty controlling body movements
Taking antipsychotic medications like iloperidone (Fanapt) can cause uncontrolled body movements (tardive dyskinesia), such as eye-twitching or lip-smacking. This is more likely to happen the longer you take medications like iloperidone (Fanapt). This can become permanent if it's not caught in time. If you experience any uncontrolled movements and aren't able to stop them, talk to your healthcare professional right away.
Changes in blood pressure and higher risk of falls
Risk factors: Low blood pressure | Taking medications that lowers blood pressure | History of medical conditions that can lower blood pressure | High iloperidone (Fanapt) doses
Iloperidone (Fanapt) can make you tired, lower your blood pressure, or lose your balance, which can lead to falls. When standing from a sitting or lying position, make sure to get up slowly and hold onto something. If you experience a fall while taking iloperidone (Fanapt), contact your healthcare professional.
Risk of infection (from low white blood cell count)
Risk factors: History of low blood cell counts
Though rare, iloperidone (Fanapt) can lower your white blood cell counts (WBCs) and put you at risk for developing infections. You'll need to get blood tests done regularly during the first few months of taking iloperidone (Fanapt) so your healthcare professional can make sure your WBCs are in a safe range. If your WBC count drops too low, you'll likely need to stop taking iloperidone (Fanapt). If you develop any signs of infection, such as fever, tiredness, chills, cough, or trouble breathing, and they don't go away, contact your healthcare professional right away.
Seizures
Risk factors: History of seizures | Health conditions that make it easier to get seizures
Iloperidone (Fanapt) can potentially cause seizures. Before starting this medication, let your healthcare professional know if you have a history of seizures or have a medical condition that puts you at risk for getting seizures.
High prolactin levels
Antipsychotics like iloperidone (Fanapt) can raise the levels of prolactin in your body. High prolactin can lead to fertility problems, enlarged male breasts, sexual dysfunction, and absence or irregular menstrual periods. Your healthcare professional will likely measure your prolactin levels during treatment to make sure they aren't too high.
Difficulty concentrating and extreme sleepiness
Risk factors: Taking high doses of iloperidone (Fanapt) | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness
Iloperidone (Fanapt) can cause extreme sleepiness and lower your ability to think, react, and focus. Your risk is higher if you're also taking other medications that can cause drowsiness, such as benzodiazepines, anxiety medications, muscle relaxants, and sleep medications. Make sure you know how this medication affects you before driving a car or doing activities that require your concentration. Talk to your healthcare professional right away if you feel too sleepy from taking iloperidone (Fanapt).
Prolonged and painful erection
Although rare, iloperidone (Fanapt) can cause prolonged and painful erections, which sometimes requires surgery to treat. If you develop a prolonged erection that lasts longer than 4 hours, get medical attention right away.
Intraoperative floppy iris syndrome (IFIS)
Don't start iloperidone (Fanapt) if you're scheduled to have cataract or glaucoma surgery. Based on how iloperidone (Fanapt) works in the body, this medication might make it more challenging for the ophthalmologist to perform the surgery. But if you're already taking iloperidone (Fanapt) and need cataract or glaucoma surgery, let your ophthalmologist know. They might need to make adjustments to how they perform the procedure.
Iloperidone (Fanapt) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 8 tablets | 1 titration pack | $253.65 | $253.65 |
Typical dosing for Iloperidone (Fanapt)
Schizophrenia: The typical starting dose is 1 mg by mouth twice per day. Your psychiatrist will slowly raise the dose over the course of a few days. The typical maintenance dose ranges from 6 mg to 12 mg twice daily.
Bipolar I disorder (brand name Fanapt only): The typical starting dose is 1 mg by mouth twice per day. Your psychiatrist will slowly raise the dose over the course of a few days. The typical maintenance dose is 12 mg twice daily.
Your dose will differ if you have liver problems, if you're taking other medications that interact with iloperidone (Fanapt), and if you have certain genetics that affect how well iloperidone (Fanapt) is broken down in the body.
Interactions between Iloperidone (Fanapt) and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bepridil
- Bromopride
- Cisapride
- Dronedarone
- Fluconazole
- Ketoconazole
- Mesoridazine
- Metoclopramide
- Nelfinavir
- Pimozide
- Piperaquine
- Posaconazole
- Saquinavir
- Sparfloxacin
- Terfenadine
- Thioridazine
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acecainide
- Ajmaline
- Alfuzosin
- Amiodarone
- Amisulpride
- Amitriptyline
- Amoxapine
- Anagrelide
- Apomorphine
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Artemether
- Asenapine
- Astemizole
- Atazanavir
- Azimilide
- Azithromycin
- Bedaquiline
- Bretylium
- Buprenorphine
- Buserelin
- Ceritinib
- Chloroquine
- Chlorpromazine
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clofazimine
- Clomipramine
- Clozapine
- Cobicistat
- Crizotinib
- Cyclobenzaprine
- Dabrafenib
- Dasatinib
- Degarelix
- Delamanid
- Desipramine
- Deslorelin
- Deutetrabenazine
- Disopyramide
- Dofetilide
- Dolasetron
- Domperidone
- Donepezil
- Droperidol
- Efavirenz
- Encorafenib
- Entrectinib
- Erythromycin
- Escitalopram
- Fingolimod
- Flecainide
- Fluoxetine
- Formoterol
- Foscarnet
- Fostemsavir
- Gatifloxacin
- Gemifloxacin
- Glasdegib
- Gonadorelin
- Goserelin
- Granisetron
- Halofantrine
- Histrelin
- Hydroquinidine
- Hydroxychloroquine
- Hydroxyzine
- Ibutilide
- Idelalisib
- Imipramine
- Indinavir
- Inotuzumab Ozogamicin
- Itraconazole
- Ivabradine
- Ivosidenib
- Lapatinib
- Lefamulin
- Lenvatinib
- Levofloxacin
- Lofexidine
- Lumefantrine
- Macimorelin
- Mefloquine
- Methadone
- Metronidazole
- Mifepristone
- Mirtazapine
- Moxifloxacin
- Nafarelin
- Nefazodone
- Nilotinib
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Ozanimod
- Paliperidone
- Panobinostat
- Pasireotide
- Pazopanib
- Pimavanserin
- Pitolisant
- Ponesimod
- Procainamide
- Prochlorperazine
- Promethazine
- Propafenone
- Protriptyline
- Quetiapine
- Quinine
- Ranolazine
- Remifentanil
- Ribociclib
- Ritonavir
- Selpercatinib
- Sematilide
- Sertraline
- Sevoflurane
- Siponimod
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Solifenacin
- Sorafenib
- Sotalol
- Sulpiride
- Sunitinib
- Tacrolimus
- Tedisamil
- Telavancin
- Telithromycin
- Tetrabenazine
- Toremifene
- Trazodone
- Triclabendazole
- Trifluoperazine
- Trimipramine
- Triptorelin
- Vandetanib
- Vardenafil
- Vemurafenib
- Vinflunine
- Voclosporin
- Voriconazole
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Iloperidone (Fanapt) cost?
What are alternatives to Iloperidone (Fanapt)?
Schizophrenia in adults
Manic or mixed episodes of bipolar I disorder in adults (brand name Fanapt only)
Schizophrenia - people ages 13 years and older
Manic or mixed episodes associated with bipolar I disorder - people ages 10 years and older
Irritability associated with autism - children ages 5 to 17 years old
Schizophrenia in people age 13 years and older
Depression from bipolar disorder in people age 10 years and older
Add-on therapy to lithium (Lithobid) or divalproex (Depakote) for depression from bipolar disorder in adults
What is the latest news about Iloperidone (Fanapt)?
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References
Best studies we foundCaccia, S., et al. (2010). New atypical antipsychotics for schizophrenia: Iloperidone. Drug Design, Development and Therapy.
Drugs and Lactation Database (LactMed®). (2022). Iloperidone. National Institute of Child Health and Human Development.
Keepers, G. A., et al. (2020). The American Psychiatric Association Practice Guideline for the treatment of patients with schizophrenia. American Journal of Psychiatry.
Montes, A. B., et al. (2009). Iloperidone (Fanapt): An FDA-approved treatment option for schizophrenia. Pharmacy and Therapeutics.
Mylan Pharmaceuticals Inc. (2022). Iloperidone tablet [package insert]. DailyMed.
Simon, L. V., et al. (2023). Neuroleptic malignant syndrome. StatPearls.
Torres, R., et al. (2024). Efficacy and safety of iloperidone in bipolar mania: A double-blind, placebo-controlled study. The Journal of Clinical Psychiatry.
U.S. Food and Drug Administration. (2017). FDA Drug Safety Communication: Antipsychotic drug labels updated on use during pregnancy and risk of abnormal muscle movements and withdrawal symptoms in newborns.
Vanda Pharmaceuticals Inc. (2024). Fanapt- iloperidone tablet; Fanapt- iloperidone [package insert]. DailyMed.
Vanda Pharmaceuticals Inc. (2024). Fanapt- iloperidone tablet; Fanapt- iloperidone kit [package insert]. DailyMed.
You and Your Hormones. (2023). Prolactin.
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