Ventricular premature contractions associated with iloperidone
A 29-year-old male with a 9-month history of paranoid schizophrenia had failed to tolerate trials of risperidone (6 mg/day) with trihexyphenidyl (4 mg/day) and, later, olanzapine (10 mg/day); the former because of extrapyramidal symptoms, and the latter because of marked (12 kg) weight gain. He was therefore switched to iloperidone 2 mg/day. The dose was stepped up to 8 mg/day, and then to 16 mg/day. The antipsychotic response to iloperidone was good, but with dosing above 8 mg/day, he reported palpitations and breathlessness with symptoms present even at rest.\nA physician diagnosed and counseled him for anxiety, apparently because his ECG was normal. However, 7 days later, progressive exacerbation of symptoms led him to visit a cardiologist. After investigations that included a 2D echocardiogram and color doppler study, VPCs were diagnosed. The frequency of the VPCs could not be determined because diagnosis was based on observation during 2D echocardiography and not on ECG. Iloperidone was abruptly withdrawn and replaced by asenapine 10 mg/day. There was relief from the palpitations and breathlessness within 2-3 days of discontinuation of iloperidone. The patient remains well on asenapine 10 mg/day, and is free from cardiac symptoms at a 2-month follow up.