Fanapt Long-Term Effects: Understanding the Risks

Alternative to Meds Editorial Team
Medically Reviewed by ATMC Clinical Review Team

Could there be Other Ways to Find Relief Besides a Lifetime on Medication?

[ “bluebg”]

What are the Concerns about Long-Term Fanapt Use?

Antipsychotics including Fanapt are most often prescribed for long periods of time. This drug has been around for 15 years, so clinicians are hopefully developing a more complete understanding of any long-term effects of concern. A careful search was done to find published research and clinical info from which the following list was derived, in addition to what is published on the drug’s FDA-approved label and prescribing information.^1-4

Some concerns about long-term effects of Fanapt can include:

• Raised blood sugar levels, weight gain
• Changes in heart rhythm, potentially life-threatening
• Abnormal, uncontrollable facial or body movements that can become permanent
• Liver damage
• Lowered white blood cell count
• Increased prolactin levels, leading to male breast enlargement, pain, discharging breast milk
• In females, increased prolactin can lead to menstrual difficulties and bone loss
• Reduced cognitive skills, impaired judgement and motor skills
• Dysphagia (inability to swallow) leading to malnutrition, pneumonia, choking
• Dopamine super sensitivity psychosis (explained more below)
• Overall increased chance of death

How to Report Long-Term Effects after Fanapt Use

These may not be all the long-term effects of Fanapt. If you or someone you know has experienced other concerning effects after taking Fanapt, you can let the FDA know on the FDA’s reporting portal for adverse reactions to drugs. In so doing, you may be helping others documenting similar experiences.

What is Fanapt?

Fanapt is the name of an antipsychotic medication that is used to treat schizophrenia and manic or mixed episodes in bipolar disorders. The medication primarily is proposed to target serotonin and dopamine, which are natural transmitters in the human body. However, it should be noted that the exact mechanisms of how it works or what it does to these or other hormones and neurotransmitters remains largely unknown.

How is Fanapt Different from Other Antipsychotics?

The “Lancet” published a scoping review comparing 32 different antipsychotic medications, including Fanapt. The study measured differences in effect, how well the drug dampened unwanted symptoms, and other measurable effects. The study found that 6 of the 32 medications worked better at dampening unwanted symptoms than the remaining 28. The remaining drugs, which group included Fanapt, had very little differences between them in this regard.³

Fanapt Long-Term and Weight Gain, Akathisia, Sedation

In other areas surveyed, Fanapt, or generic iloperidone, caused less weight gain than most others in the comparison, and less instances of akathisia. Increased prolactin levels were greater in Fanapt than about half of the other antipsychotics in the trial. While virtually all of the antipsychotics caused sedation, Fanapt caused less of this effect than 27 other antipsychotics.

Fanapt and Acetylcholine Suppression

Fanapt was in the group that had the highest rates for anticholinergic effects as compared to placebo. A drug which suppresses expression of acetylcholine in the body is called anticholinergic medication. Acetylcholine has a wide range of functions and is an important neurotransmitter for managing many body functions.⁷

Some of the functions of the neurotransmitter acetylcholine include:

• Regulates heart muscle contractions
• Allows for voluntary muscle movements
• Manages spinal messaging outward to other nerve channels
• Digestion, peristalsis in excretion
• Glandular secretions
• Rapid messaging to immune system when needed
• In the male, causes erections
• Manages respiration

Acetylcholine is an often overlooked neurotransmitter, but clearly is an important part of a functioning human nervous system and the many areas that it helps manage.

Anticholinergic Side Effects with Long-Term Fanapt

Fanapt’s anticholinergic effects especially over time can include heightened risk of dementia, serious heart problems, digestive issues, confusion, and difficulty in urination. Urinary retention over the long-term, may lead to infections, or kidney injury.

Eye problems are also noted as an anticholinergic side effect of drugs, including tightening of some eye muscles and relaxation of other eye muscles that are needed for focus. Other effects on the eyes can include dilated pupils, increased eye pressure, increased risk of glaucoma, and drying of the eye tissues. These can lead to blurry vision and other long-term problems. The longer an anticholinergic drug is taken, the higher the risk for these problems to worsen over time. If a body becomes too saturated with anticholinergic medication, either from too high a dose or from taking it long-term, toxicity can occur.

Signs of Anticholinergic Drug Toxicity

Rarely life-threatening, anticholinergic toxicity effects nonetheless require hospitalization to bring the person’s health back to optimum.⁸

There is a mnemonic used to describe the toxic side effects of anticholinergic drugs, as follows:

• Red as a beet (flushing)
• Dry as a bone (dry mouth, mucous membranes, eyes, etc.)
• Blind as a bat (blurred vision)
• Mad as a hatter (symptoms can include hallucination, confusion, agitation, delirium)
• Hot as a hare (fever)
• Full as a “flask” (urinary retention)

Additional signs of central nervous system toxicity may include seizures, jerking muscle movements, picking at bedclothes, staccato speech. These signs of CNS toxicity are associated with long-term use of Fanapt or any of the other thousands of drugs which can have anticholinergic side effects.

Other Long-Term Side Effects of Fanapt

These may not be all the long-term effects of Fanapt, but are some that have been studied in a clinical context. Virtually all antipsychotic medications can have long-term effects. Some research has pointed to the dopamine supersensitivity psychosis, or other symptoms observed after long-term antipsychotic use.^5,6

According to clinical trials out of the UK, it was found that many persons experience side effects after the long-term use of antipsychotic medications, and upon dose reduction feel a reduction in these side effects such as emotional blunting, mental clouding, or over-sedation. Some persons did better than others when it came to dose reduction, and researchers concluded this should be a highly personalized choice.⁹

If a person feels their medication has stopped working well, or has concerns about additional side effects developing, a prescriber may be able to offer alternatives to consider to avoid other long-term side effects, and to still reduce the unwanted symptoms that led to being medicated in the first place.^9,10

Additional Information on Fanapt Long-Term Effects, Antipsychotic Alternatives, and Withdrawal Strategies

You may find much additional information on the ATMC website on the above topics. For example, additional recommended reading material can be found here:

for Help with Fanapt’s Long-Term Effects

Sources:

---

1. FDA Drug Label Fanapt (iloperidone) tablets for oral use, approval 2009 [cited Jan 29 2026]

2. Leucht S, Schneider-Thoma J, Burschinski A, Peter N, Wang D, Dong S, Huhn M, Nikolakopoulou A, Salanti G, Davis JM. Long-term efficacy of antipsychotic drugs in initially acutely ill adults with schizophrenia: systematic review and network meta-analysis. World Psychiatry. 2023 Jun;22(2):315-324. doi: 10.1002/wps.21089. PMID: 37159349; PMCID: PMC10168166. [cited Jan 29 2026]

3. Vincent, Phillippe D et al., Efficacy of antipsychotic drugs for schizophrenia The Lancet, Volume 382 Issue 9908, 1873-1874 [cited Jan 29 2026]

4. Fanapt Safety Information published online 2024 by the drug manufacturer [cited Jan 29 2026]

5. Chouinard G, Samaha AN, Chouinard VA, Peretti CS, Kanahara N, Takase M, Iyo M. Antipsychotic-Induced Dopamine Supersensitivity Psychosis: Pharmacology, Criteria, and Therapy. Psychother Psychosom. 2017;86(4):189-219. doi: 10.1159/000477313. Epub 2017 Jun 24. PMID: 28647739. [cited Jan 29 2026]

6. Seeman P. All roads to schizophrenia lead to dopamine supersensitivity and elevated dopamine D2(high) receptors. CNS Neurosci Ther. 2011 Apr;17(2):118-32. doi: 10.1111/j.1755-5949.2010.00162.x. PMID: 20560996; PMCID: PMC6493870. [cited Jan 29 2026]

7. Christian S, Bordoni B, Stat Pearls Acetylcholine Physiology April 2023 [cited Jan 29 2026]

8. Broderick E, Metheny H, Anticholinergic Toxicity published/updated 4/30/2023 [cited Jan 29 2026]

9. Morant N, Long M, Jayacodi S, Cooper R, Akther-Robertson J, Stansfeld J, Horowitz M, Priebe S, Moncrieff J. Experiences of reduction and discontinuation of antipsychotics: a qualitative investigation within the RADAR trial. EClinicalMedicine. 2023 Sep 28;64:102135. doi: 10.1016/j.eclinm.2023.102135. PMID: 37936655; PMCID: PMC10626156. [cited Jan 29 2026]

10. Declercq T, Petrovic M, Azermai M, Vander Stichele R, De Sutter AI, van Driel ML, Christiaens T. Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD007726. doi: 10.1002/14651858.CD007726.pub2. PMID: 23543555.

---

Originally Published January 30, 2026 by Diane Ridaeus