Hypotension, Orthostatic Hypotension, and Bradycardia:
causes dose-dependent hypotension, orthostatic hypotension, and bradycardia.
In clinical studies with IGALMI, patients were excluded if they had treatment
with alpha-1 noradrenergic blockers, benzodiazepines, other hypnotics or
antipsychotic drugs four hours prior to study drug administration; had
a history of syncope or syncopal attacks; SBP < 110 mmHg; DBP < 70
mmHg; HR < 55 beats per minute; or had evidence of hypovolemia or orthostatic
hypotension. Because IGALMI decreases sympathetic nervous system activity,
hypotension and/or bradycardia may be more pronounced in patients with
hypovolemia, diabetes mellitus, or chronic hypertension, and in geriatric
patients. Avoid use of IGALMI in patients with hypotension, orthostatic
hypotension, advanced heart block, severe ventricular dysfunction, or history
of syncope. After IGALMI administration, patients should be adequately
hydrated and should sit or lie down until vital signs are within normal
range. If a patient is unable to remain seated or lying down, precautions
should be taken to reduce the risk of falls. Ensure that a patient is alert
and not experiencing orthostatic hypotension or symptomatic hypotension
prior to allowing them to resume ambulation.
IGALMI is indicated for the acute treatment of agitation associated with
schizophrenia or bipolar I or II disorder in adults.
Limitations of Use: The safety and effectiveness of IGALMI have not been established beyond 24 hours from the first dose.
QT Interval Prolongation: IGALMI prolongs the
QT interval. Avoid use of IGALMI in patients at risk of torsades de pointes
or sudden death, including those with known QT prolongation, a history
of other arrhythmias, symptomatic bradycardia, hypokalemia, or hypomagnesemia,
and in patients receiving other drugs known to prolong the QT interval.
Somnolence: IGALMI can cause somnolence. Patients
should not perform activities requiring mental alertness, such as operating
a motor vehicle or operating hazardous machinery, for at least eight hours
after taking IGALMI.
Risk of Withdrawal Reactions, Tolerance, and Tachyphylaxis: IGALMI
was not studied for longer than 24 hours after the first dose. There
may be a risk of physical dependence, a withdrawal syndrome, tolerance,
and/or tachyphylaxis if IGALMI is used in a manner other than indicated.
The most common adverse reactions (incidence ≥5% and at least twice
the rate of placebo) were somnolence, oral paresthesia or oral hypoesthesia,
dizziness, dry mouth, hypotension, and orthostatic hypotension.
Drugs That Prolong the QT Interval: Avoid use.
Concomitant use of drugs that prolong the QT interval may add to the QT-prolonging
effects of IGALMI and increase the risk of cardiac arrhythmia.
Anesthetics, Sedatives, Hypnotics, and Opioids:
use may cause enhanced CNS-depressant effects. Reduction in dosage of IGALMI
or the concomitant medication should be considered.
Hepatic Impairment and Geriatric Patients (≥65 years old):
lower dose is recommended in patients with hepatic impairment and geriatric
patients. See the full Prescribing Information for the recommended dosage
depending on the agitation severity.