Iloperidone: A new drug for the treatment of schizophrenia

• Published in: American journal of health-system pharmacy 2011-02, Vol.68 (4), p.301-308
• Main Authors: Arif, Sally A, Mitchell, Melissa M
• Format: Article
• Language: English
• Subjects: Antipsychotic Agents - adverse effects; Antipsychotic Agents - pharmacology; Antipsychotic Agents - therapeutic use; Dosage and administration; Drug Administration Schedule; Drug Interactions; Drug therapy; Humans; Iloperidone; Isoxazoles - adverse effects; Isoxazoles - pharmacology; Isoxazoles - therapeutic use; Pharmacokinetics; Piperidines - adverse effects; Piperidines - pharmacology; Piperidines - therapeutic use; Polymorphism, Single Nucleotide; Randomized Controlled Trials as Topic; Schizophrenia; Schizophrenia - drug therapy; Schizophrenia - genetics
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp100079

The pharmacology, pharmacokinetics, pharmacogenomics, clinical efficacy, and safety and tolerability profile of iloperidone for the treatment of schizophrenia are reviewed. Iloperidone is an atypical antipsychotic that recently received marketing approval from the Food and Drug Administration for the acute treatment of schizophrenia. Iloperidone is a pure antagonist and the first antipsychotic to have pharmacogenomic studies indicate predictive response based on six identified polymorphisms. Pharmacokinetic studies have determined that iloperidone is well absorbed orally, with a bioavailability of 96%. Phase II and III clinical trials have shown iloperidone to improve symptoms of schizophrenia, based on the Positive and Negative Symptom Scale, Brief Psychiatric Rating Scale, and Clinical Global Impressions-Severity scores (p < 0.05). Iloperidone has established tolerability at recommended dosages of up to 24 mg daily; however, the dosage must be slowly increased over seven days, and twice-daily administration is required to avoid orthostatic hypotension. The most common adverse effects associated with iloperidone were dizziness, dry mouth, fatigue, nasal congestion, orthostatic hypotension, somnolence, tachycardia, and weight gain. Safety studies have also found that iloperidone increases the risk of Q-Tc interval prolongation, similar to that seen with ziprasidone. Minimal changes in glucose and lipid abnormalities were seen in short-term (4- and 6-week) and long-term (52-week) studies, indicating a low chance of metabolic disturbance with iloperidone. Iloperidone may be a viable and safe option for the treatment of schizophrenia in adult patients, especially for patients who cannot tolerate other antipsychotic agents. However, iloperidone lacks a clear benefit over other antipsychotic agents.