From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
2.1 Recommended Dosage Titrate Iloperidone to avoid orthostatic hypotension [see Warnings and Precautions ( 5. 7)]. Administer Iloperidone orally with or without food. Table 1 includes dosage recommendations for Iloperidone for the treatment of schizophrenia in adults Indication and Titration schedule Recommended Dosage Population Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Schizophrenia 1mg twice daily 2 mg twice daily 4 mg twice daily 6 mg twice daily 8 mg twice daily 10 mg twice daily 12 mg twice daily 6 mg to 12 mg twice daily
The recommended dosage and treatment protocol for Iloperidone in schizophrenia management is to titrate the dose to avoid orthostatic hypotension, with a starting dose of 1mg twice daily and gradually increasing to 6 mg to 12 mg twice daily. The dose should be adjusted based on the patient's response and tolerance.
- Key considerations:
- Administer Iloperidone orally with or without food.
- Reduce the dose by one-half for CYP2D6 poor metabolizers.
- No dose adjustment is needed for patients with mild hepatic impairment, but patients with moderate hepatic impairment may require dose reduction.
- Reduce the dose by one-half when administered concomitantly with strong CYP2D6 inhibitors or strong CYP3A4 inhibitors.
- Follow the initiation titration schedule when reinitiating treatment after an interval of more than 3 days off Iloperidone 1.
From the Research
Iloperidone should be initiated at 1 mg twice daily for schizophrenia treatment, with a gradual titration to minimize orthostatic hypotension, as recommended by the most recent and highest quality study 2. The dose should be increased daily in increments of 2 mg total daily dose to reach the recommended target of 12-24 mg per day, usually divided into two doses. Most patients respond to doses between 6-12 mg twice daily, with the maximum recommended dose being 12 mg twice daily. Titration should follow this schedule:
- Day 1: 1 mg twice daily;
- Day 2: 2 mg twice daily;
- Day 3: 4 mg twice daily;
- Day 4: 6 mg twice daily;
- Day 5: 8 mg twice daily;
- Day 6: 10 mg twice daily;
- Day 7: 12 mg twice daily. If treatment is interrupted for more than 3 days, restart with the initial titration schedule. Iloperidone works by blocking dopamine D2 and serotonin 5-HT2A receptors, with a unique receptor binding profile that may result in fewer extrapyramidal symptoms compared to some other antipsychotics, as shown in studies 3, 4, 5. However, it requires careful monitoring for QT prolongation, especially in patients with cardiac conditions or those taking other QT-prolonging medications, as noted in 6. Regular ECG monitoring is recommended, particularly during dose adjustments. Blood pressure monitoring is also important during the initial titration period due to the risk of orthostatic hypotension. The most common adverse events associated with iloperidone were dizziness, dry mouth, somnolence, and dyspepsia, with few extrapyramidal symptoms and metabolic changes in short- and long-term studies in adults 3, 4, 6. Iloperidone may be an attractive option in patients who are particularly prone to EPS, or who are showing prominent negative symptoms, as well as cognitive deficits, as suggested by 2.