Summary

Over 50% of schizophrenia patients drop out of controlled trials within 6 months due to lack of efficacy or in some cases tolerability issues [Liu-Siefert et al. BMC Med 2005; Lieberman JA et al. N Engl J Med 2005], particularly extrapyramidal symptoms (EPS), akathisia, weight gain, metabolic effects, sedation, and anticholinergic effects. EPS and akathisia effects carry an increased risk of suicide [Dong JY et al. J Affect Disord 2005] and poor adherence, while metabolic effects can increase the risk for diabetes and cardiovascular disease. Iloperidone, a mixed D2/5-HT2 antagonist that is under US Federal Drug Administration (FDA) review, may provide a lower EPS/akathisia liability.