Lurasidone
Mechanism :
Lurasidone is a benzisothiazol-derivative atypical antipsychotic with mixed serotonin-dopamine antagonist activity. It exhibits high affinity for D2, 5-HT2A, and 5-HT7 receptors; moderate affinity for alpha2C-adrenergic receptors; and is a partial agonist for 5-HT1A receptors.
Indication :
- Bipolar depression
- Schizophrenia
- Off-Label: Major depressive disorder with mixed features; Psychosis/agitation associated with dementia
Contraindications :
Hypersensitivity to lurasidone or any component of the formulation (including angioedema); concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, ritonavir, voriconazole, mibefradil) and inducers (e.g., rifampin, avasimibe, St. John’s wort, phenytoin, carbamazepine).
Dosing :
Bipolar depression (Monotherapy):
Children ≥10 years of age and Adolescents: Oral: Initial: 20 mg once daily; may increase dose after 1 week based on response and tolerability; maximum recommended dose: 80 mg/day.
Schizophrenia:
Adolescents: Oral: Initial: 40 mg once daily; may increase dose further based on response and tolerability; maximum recommended dose: 80 mg/day.
Adverse Effect :
Extrapyramidal reaction, drowsiness, akathisia, Parkinson-like-syndrome, insomnia, hyperglycemia, hypertriglyceridemia, nausea, viral infection, tachycardia, weight gain, vomiting, dyspepsia.
Interaction :
CYP3A4 Inducers: May decrease the serum concentration of Lurasidone.
CYP3A4 Inhibitors: May increase the serum concentration of Lurasidone.
Hydrocodone and Hydroxyzine: CNS Depressants may enhance the CNS depressant effect.
Metoclopramide: May enhance the adverse/toxic effect of Antipsychotic Agents.
Hepatic Dose :
Mild hepatic impairment: No dose adjustment required.
Moderate hepatic impairment: Initially give 20 mg/day PO. Max: 80 mg/day.
Severe hepatic impairment: Initially, give 20 mg/day PO. Max: 40 mg/day.