Lurasidone
Indications
Lurasidone is used for:
Schizophrenia & bipolar depression.
Adult Dose
Schizophrenia
40 mg PO once daily initially; may increase to 80 mg/day if needed; not to exceed 160 mg/day
Bipolar Depression
Indicated for major depressive episodes associated with bipolar I disorder; may be used as either monotherapy or adjunctive therapy with lithium or valproate
20 mg PO once daily initially; may increase dose if needed, not to exceed 120 mg/day
Hepatic impairment
Mild (Child-Pugh class A): Dosage adjustment may not be necessary; use caution
Moderate (Child-Pugh class B): 20 mg/day initially; not to exceed 80 mg/day
Severe (Child-Pugh class C): 20 mg/day initially; not to exceed 40 mg/day
Child Dose
Safety and efficacy not established
Renal Dose
Renal impairment
CrCl 50 mL/min or greater: Dosage adjustment not required
CrCl <50 mL/min: 20 mg/day initially; not to exceed 80 mg/day
Administration
Should be taken with food
Contra Indications
Hypersensitivity. Concurrent administration of strong CYP3A4 inhibitors (eg, Ketoconazole). Concurrent administration of strong CYP3A4 inducers (eg, Rifampin).
Dementia-related psychosis.
Precautions
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants
Cerebrovascular adverse reactions in elderly patients with dementia-related psychosis: Increased incidence of cerebrovascular adverse events (e.g., stroke, transient ischemic attack).
Neuroleptic malignant syndrome: Manage with immediate discontinuation and close monitoring.
Tardive dyskinesia: Discontinue if clinically appropriate.
Metabolic changes: Atypical antipsychotic drugs have been associated with metabolic changes that may
increase cardiovascular/cerebrovascular risk. These metabolic changes include hyperglycemia, dyslipidemia, and weight gain.
Hyperglycemia and diabetes mellitus: Monitor patients for symptoms of hyperglycemia including polydipsia,
polyuria, polyphagia, and weakness. Monitor glucose regularly in patients with diabetes or at risk for diabetes.
Dyslipidemia: Undesirable alterations have been observed in patients treated with atypical antipsychotics.
Weight Gain: Gain in body weight has been observed. Monitor weight.
Hyperprolactinemia: Prolactin elevations may occur.
Leukopenia, neutropenia and agranulocytosis: Perform complete blood counts (CBC) in patients with a
pre-existing low white blood cell count (WBC) or a history of leukopenia or neutropenia. Consider discontinuing Lurasidone if a clinically significant decline in WBC occurs in the absence of other causative factors.
Orthostatic hypotension and syncope: Dizziness, tachycardia or bradycardia, and syncope may occur, especially early in treatment. In patients with known cardiovascularor cerebrovascular disease, and in antipsychotic-naïve patients, consider a lower starting dose and slower titration.
Lactation: Unknown whether drug is distributed in breast milk; use caution
Pregnancy-Lactation
Interactions
Adverse Effects
Side effects of Lurasidone :
>10%
Somnolence, dose related (22%),Akathisia, dose related (15%),Fasting glucose increased (10-14%),Nausea (12%),Parkinsonism (11%)
1-10%
Vomiting (8%),Dyspepsia (8%),Anxiety (8%),Agitation (6%),Anxiety (6%),Dystonia (5%),Dizziness (5%),Fatigue (4%),Back pain (4%),Restlessness (3%),Salivary hypersecretion (2%)
Mechanism of Action
Partial agonist at serotonin 5-HT 1A receptors, and antagonist at dopamine D 2 and serotonin 5-HT 2A receptors.