Fanapt (Iloperidone) is an atypical antipsychotic that was approved by the FDA on May 6, 2009 for the treatment of schizophrenia. The drug is thought to have been synthesized in the 1990s, during which its rights were sold from Hoechst Marion Roussel Inc. to Titan Pharmaceuticals, and eventually to Vanda Pharmaceuticals. It functions as an antagonist aimed at various serotonergic and dopaminergic receptors.
Specifically, Fanapts mechanism of action elicits potent effects as an antagonist at the 5-HT2A, D2, and D3 receptor sites. It also elicits moderate antagonist effects at the D4, 5-HT6, 5-HT7, and Alpha-1 receptors. Although it has a complex mechanism of action, not everyone responds well to Fanapt.
Research suggests that individuals with specific genetic polymorphisms (homozygous G/G for CNTF) tend to respond significantly better to Fanapt than a placebo, whereas those without this polymorphism may not derive substantial therapeutic benefit. Assuming you do not derive significant therapeutic benefit from Fanapt and/or cannot tolerate various side effects, you may decide to discontinue treatment. Upon discontinuation, you may experience a backlash of neurophysiological withdrawal symptoms.
Factors that influence Fanapt (Iloperidone) withdrawal
There are a variety of factors that will influence the severity and number of discontinuation symptoms associated with Fanapt. These factors are also thought to determine how long the withdrawal process lasts following complete cessation of the drug. Prominent influential factors include: time span, dosage, tapering speed, and individuality (e.g. genetics).
In general, the longer you’ve taken Fanapt, the greater the period of time over which your body has adapted to its presence. If you’ve been taking the drug on a daily basis since its inception in 2009, you’re likely going to have a much tougher withdrawal than someone who has taken it for several weeks and decides to discontinue. This is due to the fact that the longer period of time over which your brain and nervous system become habituated to the presence of Fanapt, the more they are relying on the drug to aid in functioning.
If you’ve only taken the drug for a short-term (e.g. several weeks or months), your nervous system may have an easier time transitioning off of the drug. More substantial neurophysiological changes are likely to ensure over a long-term of administration. Moreover, longer-term administration often results in dosage increases, which are known to complicate discontinuation.
Dosage (12 mg to 24 mg)
The starting dosage of Fanapt is generally 2 mg per day (taken in multiple doses of 1 mg). Most psychiatrists will slowly titrate patients upward until they are ingesting between 12 mg and 24 mg daily (as administered in twice-daily doses of 6 mg to 12 mg). Those who were taking higher doses of Fanapt will likely have a more debilitating withdrawal process than those who were taking lower doses.
This is due to the fact that the greater the potency (as dictated by dose), the greater the shift in endogenous homeostatic functioning. When you withdraw, your body attempts to adjust itself back to homeostasis. If you were taking a high dose, you have pushed your neurophysiology a greater distance from its homeostatic baseline.
For this reason, it is always recommended to take the minimal effective dose for symptomatic management rather than blindly ingesting the highest (or a supratherapeutic dose). In addition to dose influencing withdrawal severity, it is important to consider the relation of dose to bodyweight and metabolism. Someone taking a high dose relative to bodyweight and metabolism, may have a significantly tougher time enduring discontinuation.
Cold turkey vs. Tapering
Another factor to consider when discontinuing Fanapt is whether you’ve quit “cold turkey” or conducted a taper. If you quit cold turkey, you can expect the immediate neurophysiological backlash to be of greater severity than if you had gradually tapered off of the medication. Discontinuing cold turkey gives your brain and nervous system no time to adjust to functioning without the drug.
Those that quit cold turkey (especially after a long-term) often find that they endure a protracted withdrawal, much longer and more traumatic than had they tapered. Cold turkey is not advised for most people due to the fact that it’s analogous to ripping a bandage off of a wound that’s profusely bleeding and clearly not healed. On the other hand, conducting a gradual taper is like gradually removing one layer of the bandage at a time until none is required.
In most cases, it is recommended to follow a conservative tapering schedule of just 10% dosage reductions per month. This means that if you were taking 24 mg per day of Fanapt, dosage would be cut to 21.6 mg for the first month. Assuming you think 10% is too slow (or too fast), you can always make adjustments based on how you feel.
Failing to consider individuality during withdrawal is a major mistake. Certain people recover from withdrawal symptoms at a much quicker rate than others. It is clear that certain genes may play a role in facilitating recovery. Someone with favorable genetics may clear the Fanapt from their system quicker and revert back to homeostasis sooner than other person.
That said, we are all humans and have many genes in common. Generally, other factors such as daily habits and lifestyle play a greater role in determining withdrawal outcomes than genes. Someone who is: getting sufficient sleep, proactively taking measures to reduce stress, eating a healthy diet, exercising daily, staying socially engaged, and keeping busy – will likely expedite their recovery time.
People who aren’t making an effort to eat healthy foods, stay busy, get exercise, and/or reduce stress – may have more debilitating withdrawal symptoms. In addition, it is important to consider the fact that other psychiatric medications, supplements, and even illicit drugs may blunt withdrawal symptoms. Those that are ingesting other psychoactive substances may mitigate many withdrawal symptoms as a result; keep in mind that these substances may also have withdrawal symptoms.
Fanapt (Iloperidone) Withdrawal Symptoms: List of Possibilities
Below is a list of possible withdrawal symptoms that you may endure upon discontinuation of Fanapt. Understand that the number of symptoms you experience is subject to significant individual variation. Most people will not experience every last symptom on this list, but experiencing multiple symptoms is relatively common.
- Agitation: Some people become severely agitated when they attempt to discontinue Fanapt. This agitation may be notable as an individual reduces their dosage during a taper, but may be more unbearable after a person has completely discontinued. If you are feeling inner nervousness, restlessness, and agitated – understand that many others have the same experience during withdrawal.
- Anxiety: A very common Fanapt discontinuation symptom is anxiety. If your level of anxiety shoots through the roof and is higher than ever before, it’s likely due to recalibration of neurotransmission. Fanapt acts as an antagonist on serotonergic and dopaminergic receptors, many of which modulate anxiety. When the drug is stopped, resulting neurochemical deficits may provoke severe anxiety.
- Cognitive impairment: It is common for people to experience attentional deficits, brain fog, and difficulty with memory retrieval upon discontinuation of this drug. The readjustment of neurotransmission following discontinuation of Fanapt may take weeks or months. As a result, withdrawal-induced abnormalities of neurochemistry lead to impaired cognition. The cognitive impairment may increase difficulty of performing at school or an occupation.
- Confusion: Due to the multitude of discontinuation symptoms that people experience, they may experience confusion. When you’re hit with physical symptoms that make you feel sick, and mental symptoms such as impaired cognition – it makes sense that some discontinuers will feel stuck in a state of confusion. The confusion should improve after several weeks of complete cessation.
- Depersonalization: An uncomfortable discontinuation symptom to experience is that of depersonalization. Many people become depersonalized, feeling as if they are no longer their authentic self. A good way to describe depersonalization is as if someone else entered your body and brain – you no longer feel in touch with your homeostatic self. While depersonalization should fade in time, anxiety can exacerbate it – so try your best to avoid getting anxious over it.
- Depression: Many people experience severe depression when quitting antipsychotics like Fanapt. The depression is generally caused as a result of the brain expecting the drug to help regulate mood. Since Fanapt is no longer administered, the brain is forced to function without the serotonergic and dopaminergic modulation it had previously received – this can lead to severe depression.
- Diarrhea: Some users have reported that they experience an upset stomach and diarrhea when they stop taking Fanapt. Assuming you aren’t able to control your bowel movements, understand that the diarrhea shouldn’t last more than a few weeks. It’s a physiological reaction triggered upon brisk removal of a pharmacological agent that the body had adapted to accommodate. Consider taking some over-the-counter Imodium to combat this symptom.
- Dizziness: Those that discontinue Fanapt rapidly and/or cold turkey are at significant risk of experiencing dizziness. The dizziness may be analogous to getting on an amusement park ride that spins rapidly in a circle. It may feel as if your equilibrium is imbalanced and as if you’re dealing with severe vertigo. Understand that dizziness is normal and can sometimes be ameliorated with a slower taper.
- Fatigue: Don’t be surprised if you end up feeling extremely lethargic and unable to get out of bed. The fatigue may be severe and you may think that you’ll never recover from such low energy. While some people may feel more energized during withdrawal as a result of increased arousal, others may become more tired than usual and find it difficult to sustain any motivation.
- Flu-like symptoms: The combination of nausea, headache, dizziness, confusion, and fatigue – make the discontinuation process akin to coming down with the flu. Many people report flu-like symptoms when they discontinue antipsychotics, including Fanapt. In fact, some people are so unaware of withdrawal that they assume they are physically sick with a virus.
- Headaches: Experiencing a headache when stopping Fanapt is extremely common. In fact, headaches are among the several most common of all discontinuation symptoms. Some people will experience minor, intermittent headaches – whereas others may end up dealing with round-the-clock migraines. Do your best to minimize stress, eat healthy, and stay hydrated to reduce headaches. Further, consider conducting a slower withdrawal if the headaches become too severe.
- Heart palpitations: Heart palpitations are extremely uncomfortable, and characterized as a rapid, strong, or irregular heart beat. Typically these can stem from physiological reactions to drug withdrawal, but can also be triggered by anxiety and agitation. Assuming you taper slowly and don’t allow yourself to be consumed with anxiety – these shouldn’t be long-lasting.
- Insomnia: Many people find it difficult to fall asleep at night when they initially stop Fanapt. In addition, they may notice that they wake up throughout the night and/or too early in the morning. Insomnia is generally caused by increased arousal and imbalanced neurochemistry following cessation of Fanapt. You may want to consider working with a doctor and/or considering supplements to help mitigate insomnia if it becomes overwhelming.
- Irritability: If you notice yourself becoming increasingly irritable when you stop Fanapt, it’s probably more than just a coincidence. Your brain no longer is receiving the serotonergic and dopaminergic effects of the drug. This means that you’ll likely have a difficult time regulating your emotions, and seemingly benign events and/or things may provoke anger and hostility.
- Mood swings: During discontinuation, it can take awhile before endogenous levels of neurotransmitters and receptors are restored. As a result, you may have days where you feel relatively optimistic, and others when you feel severely depressed. At other times you may feel angry, excited, or depersonalized. These mood changes tend to occur most often in the early days of withdrawal, and over time your mood should return back to a homeostatic baseline.
- Muscle pain: Some people report feeling muscle pain, joint stiffness, and body aches during withdrawal. This is due to the fact that there are often physical reactions associated with psychotropic drug discontinuation. Those that quit cold turkey from high doses are more likely to experience muscle pains compared to those who taper.
- Nausea: Quitting Fanapt abruptly may result in feeling nauseated. Nausea is a common withdrawal symptom, but a proper tapering regimen can minimize it. Most people will find that nausea tends to significantly diminish within several weeks of medication cessation. Unfortunately, if severe enough the nausea may provoke vomiting.
- Restlessness: If you feel restless during withdrawal, your best bet may be to get some light exercise (e.g. go for a walk). However, if you’re not up for physical exercise, engaging in a relaxing activity to tone down the sympathetic nervous system may provide substantial benefit. Understand that the restlessness associated with withdrawal is likely due to complex neurophysiological responses to discontinuation.
- Sleep problems: Most people will experience some changes in their sleep cycle when stopping Fanapt. This may mean that their circadian rhythm is thrown out of whack, their sleep quality is diminished (as a result of lack of slow-wave sleep), or even that they cannot sleep enough due to insomnia. Sleep problems can often be targeted with safe pharmaceuticals and/or supplements under professional supervision.
- Suicidal thoughts: If you’re experiencing an uptick in suicidal thoughts during Fanapt withdrawal, it is advised to seek immediate medical attention. In addition, you may want to consider working with a psychotherapist to discuss your suicidal ideation. Assuming you were not suicidal prior to taking the medication, the feeling of wanting to die should not be long-lasting following cessation of the med.
- Sweating: A common response to discontinuing Fanapt is excess sweating. You may sweat throughout the day, but it is also common to experience night sweats. Sweating is a detoxification mechanism employed by the body to clear the drug, but also may be a reaction to the nervous system expecting the drug and no longer getting it.
- Tremors: If your body and limbs start to shake, you may be experiencing withdrawal-induced tremors. These shakes can usually be avoided with a more gradual tapering schedule. Work with a medical professional to determine how you should deal with this symptom if it becomes debilitating.
- Vomiting: In very severe cases of withdrawal, a person may end up becoming so nauseous that they vomit. Both vomiting (and the nausea that causes it) can often be mitigated by conducting a slower withdrawal. Those that end up puking tend to have dropped from high doses to 0 mg without any gradual transition.
- Weight changes: In some cases, taking Fanapt causes modest weight gain in select individuals. Assuming you experienced weight gain on the drug, you will likely end up losing that weight during discontinuation. If you ended up losing weight on Fanapt, you may end up gaining some of the weight back upon discontinuation.
How long do Fanapt (Iloperidone) withdrawal symptoms last?
It would be nice if everyone knew exactly what to expect when they discontinued Fanapt with a perfectly planned withdrawal timeline. Unfortunately, the withdrawal process is subject to significant individual variation. For one person, withdrawal symptoms may not even get noticed and the person may continue functioning unaware of any significant discontinuation.
For most people, withdrawal symptoms will last several weeks, and gradually diminish in intensity. Among those that have been on the drug over a long-term, at a higher dosage, and rapidly discontinued – it may take several months before symptoms subside. In rare cases, protracted withdrawals may span longer than several months.
In any regard, it is important to take the process one day at a time and avoid succumbing to the illusion that you should feel better overnight and/or within a few days. To ensure optimal recovery, be sure to work with your psychiatrist and consider engaging in psychotherapy. Moreover, it is important to do everything in your power (e.g. eat healthy, get enough sleep, etc.) to enhance recovery efforts.
For many people it helps to track withdrawal symptom improvement in a journal. Journaling is often helpful due to the fact that it allows you to gauge changes over time – understanding that you are healing and slowly reverting back to neurophysiological homeostasis. You may want to use the 90 day marker (3 months) as a checkpoint due to the fact that at this point, many people experience significant improvement.
Have you experienced withdrawal symptoms from Fanapt?
If you’ve discontinued Fanapt, feel free to share any withdrawal symptoms that you’ve experienced in the comments section below. Also mention how long your withdrawal lasted and how you managed to cope with the symptoms. Understand that since Fanapt is a relatively new antipsychotic and not many people have used it, there aren’t as many reports on the withdrawal process as there will be in forthcoming years.