Fanapt: Hope or Hype?

by Christina Bruni Patient Expert

Early next year Vanda Pharmaceutical's schizophrenia drug Fanapt (generic: Iloperidone) will hit the pharmacy shelves. Could it be the first third-generation atypical? It blocks a different combination of neurotransmitters than earlier antipsychotics. The company says Fanapt targets a more relevant set of neurotransmitters, so that patients are likely to experience fewer side effects than with other medications. The drug has been in development for 10 years and after a negative ruling from the FDA is back on the market. It was originally not approved after Vanda told the regulatory agency they had misinterpreted some data.

You can read the full U.S. prescribing information at the Fanapt website or get information at a popular drugs site. After reading this, you can decide for yourself if the drug is one you would consider taking. The comments posted in response to the Washington Post article that reported on this news were universally heartless. I doubt most of the posters actually had schizophrenia. One mother said she cured her son of schizophrenia without medication and would never allow him to take a drug.

That's interesting because my own mother's one true act of love was to drive me to the hospital within 24 hours of my breakdown, where I was given Stelazine, the drug that halted my positive symptoms within three weeks. Had she not done that I wouldn't have recovered. I certainly wouldn't have the life I have now.

One person recommended homeopathy and acupuncture. A truly scary response came from a guy or woman who traded in stereotypes: if you had schizophrenia, just hold a cell phone to your ear. The implication of course was that people with SZ talk to themselves and could conveniently disguise this.

The one legitimate post came from someone who just might have this disease: he hoped that Fanapt would not cause people "to become fat." Trust me: I do not believe it is right that someone should gain 100 lbs because he or she is prescribed an atypical to treat the symptoms of schizophrenia. Nobody should have to make the "sanity versus vanity" choice.

Right now, I'm lucky the drug I'm on works for me. As soon as Dr. Altman instituted the cross-titer from the old drug, I noticed an improvement within three days. A friend protests that I'm skinny because I eat healthful foods and exercise. I beg to differ. I'm skinny because I'm on Geodon and this drug did not induce a ravenous, constant appetite in me. I deal in the real: I'm one of the lucky ones. I do not like to entertain the possibility that if I were on a different drug I wouldn't be able to control my impulse to eat.

The fact is, I'm not on Zyprexa or any of the other culprits. As to whether Fanapt will cause weight gain because it increases a person's appetite, I sure hope Vanda Pharmaceutical will be upfront about that.

As with any medication you're considering taking, whether it's for a chemical imbalance in the brain or another medical condition, you have to do a risk-benefit analysis and decide at what point the risks outweigh the benefit. The benefits could outweigh the risks.

The company claims there are fewer side effects yet like with any new drug we don't know the long-term effects as it hasn't been prescribed long enough to determine them. With Zyprexa, according to my first psychiatrist, Dr. Cruz, he knew it caused weight gain even though the company said it didn't. Eli Lilly lied. Will Vanda be upfront? One would certainly hope so.

For now, I'm sticking to my trusty atypical. I see Dr. Altman a week from Friday and I'll ask him what he thinks and report back to you. As always, I'd love to hear your comments.

Christina Bruni
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Christina Bruni

Christina Bruni wrote about schizophrenia for HealthCentral as a Patient Expert. She is a mental health activist and freelance journalist.