An update on the efficacy and safety of iloperidone as a schizophrenia therapy

ABSTRACT

Introduction

Schizophrenia has a prevalence of approximately 1% in the general population, with 15.2 per 100,000 persons affected. Iloperidone is a second-generation antipsychotic drug approved for the treatment of schizophrenia in adults. It acts primarily by D2/5HT2a receptor antagonism, with greater affinity for the 5HT2a receptor than for the D2 receptor.

Areas covered

This article discusses iloperidone and aims to provide useful information for clinicians to determine which circumstances would best suit the use of iloperidone to treat schizophrenic patients. In this review, the authors briefly discuss schizophrenia and its treatment, before they discuss properties of iloperidone, its indications, approval process, and adverse effects. Finally, the authors review the specific strengths and weaknesses of the medication.

Expert opinion

Iloperidone would be an attractive option in patients who are particularly prone to EPS, or who are showing prominent negative symptoms, as well as cognitive deficits. Its availability only in an oral formulation makes it a better option for patients with good medication adherence, and though it could be useful in patients prone to weight gain or hepatic dysfunction on other second generation antipsychotics, it should be used with caution in patients prone to side effects related to alpha adrenergic blockade.

KEYWORDS:

• Iloperidone
• antipsychotic
• dopamine
• serotonin

Declaration of interest

GT Grossberg is a consultant for Acadia, Alkatest, Allergan, Avanir, Bioxcel, GE Healthcare, Genentech, Lundbeck, Novartis, Otsuka, Roche and Takeda. They are also on the safety monitoring committee of EryDel and Newron and the Data Monitoring Committee of ITI Therapeutics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One referee declares that in the past 3 years, they have received honoraria as a consultant or for lectures from LB Pharma, Otsuka, Lundbeck, Boehringer Ingelheim, LTS Lohmann, Janssen Pharmaceuticals, Johnson & Johnson, Teva Pharmaceuticals, Merck Sharp and Dohme, Sandoz, Sanofi, Angelini, Sunovion, Recordati and Gedeon Richter. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

The authors are supported by the Saint Louis University School of Medicine.