Which drugs require monitoring for orthostatic hypotension?

• A. Iloperidone and risperidone
• B. Clozapine and olanzapine
• C. Quetiapine and ziprasidone
• D. Haloperidol and chlorpromazine

Answer: (A)

Orthostatic hypotension with antipsychotics comes from alpha-1 adrenergic receptor blockade, which can cause blood vessels to dilate and blood pressure to drop when you stand up. Iloperidone and risperidone are commonly associated with this effect, especially during initiation or dose increases, so clinicians routinely monitor blood pressure in the lying and standing positions and adjust doses slowly to reduce the risk of dizziness or fainting. This monitoring is a key safety step when starting or changing these medications. While other antipsychotics can also cause orthostatic hypotension, iloperidone and risperidone are the ones most specifically highlighted for needing careful monitoring during titration.