lurasidone

lurasidone

(loo-ras-i-done) ,

Latuda

(trade name)

Classification

Therapeutic: antipsychotics
Pharmacologic: benzoisothiazole
Pregnancy Category: B

Indications

Treatment of schizophrenia.Depressive episodes associated with bipolar I disorder (as monotherapy or with lithium or valproate).

Action

Effect may mediated via effects on central dopamine Type 2 (D2) and serotonin Type 2 (5HT2A) receptor antagonism.

Therapeutic effects

↓ schizophrenic behavior.

Pharmacokinetics

Absorption: 9–19% absorbed following oral administration.
Distribution: Unknown.
Protein Binding: >99%.
Metabolism and Excretion: Mostly metabolized by the CYP3A4 enzyme system. Two metabolites are pharmacologically active; 80% eliminated in feces, 8% in urine primarily as metabolites.
Half-life: 18 hr.

Time/action profile

ROUTEONSETPEAKDURATION
POunknown1–3 hr*24 hr
*Blood level.

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Concurrent use of strong CYP3A4 inhibitors or inducers
Use Cautiously in: Renal/hepatic impairment (dose adjustment recommended for CCr of 10 mL/min–<50 mL/min or Child-Pugh Class B and C);History of suicide attempt;Diabetes mellitus;Overheating/dehydration (may ↑ risk of serious adverse reactions);History of leukopenia or previous drug-induced leukopenia/neutropenia; Geriatric: ↑ risk of seizures; elderly patients with dementia-related psychoses (↑ risk of cerebrovascular adverse reactions); use cautiously in elderly females (↑ risk of tardive dyskinesia); Obstetric: Use in pregnancy only if potential benefit justifies potential risk to fetus; Lactation: Breast feeding should only be considered if potential benefit justifies risk to child; Pediatric: May ↑ risk of suicide attempt/ideation especially during dose early treatment or dose adjustment; risk may be greater in children, adolescents, and young adults taking antidepressants (safe use in children/adolescents not established).

Adverse Reactions/Side Effects

Central nervous system

  • neuroleptic malignant syndrome
  • seizures
  • suicidal thoughts
  • akathisia (most frequent)
  • drowsiness (most frequent)
  • parkinsonism (most frequent)
  • agitation
  • anxiety
  • cognitive/motor impairment
  • dizziness
  • dystonia
  • tardive dyskinesia

Ear, Eye, Nose, Throat

  • blurred vision

Cardiovascular

  • bradycardia
  • orthostatic hypotension
  • syncope
  • tachycardia

Gastrointestinal

  • nausea (most frequent)
  • esophageal dysmotility

Dermatologic

  • pruritus
  • rash

Endocrinologic

  • hyperglycemia
  • hyperprolactinemia

Hematologic

  • agranulocytosis (life-threatening)
  • anemia
  • leukopenia

Metabolic

  • dyslipidemia
  • weight gain

Interactions

Drug-Drug interaction

Strong CYP3A4 inhibitors, including ketoconazole, clarithromycin, ritonavir, and voriconazole ↑ blood levels and risk of adverse reactions; concurrent use contraindicated.Strong CYP3A4 inducers, including rifampin, phenytoin, and carbamazepine ↓ blood levels and effectiveness; concurrent use contraindicated.Moderate inhibitors of the CYP3A4 enzyme system, including diltiazem, atazanavir, erythromycin, fluconazole, and verapamil ↑ blood levels; if used concurrently, dose of lurasidone should not exceed 40 mg/day.↑ sedation may occur with other CNS depressants, including alcohol, sedative/hypnotics, opioids, some antidepressants and antihistamines.St. John's wort ↓ blood levels and effectiveness; concurrent use contraindicatedGrapefruit juice ↑ blood levels and risk of adverse reactions; concurrent use contraindicated

Route/Dosage

Schizophrenia

Oral (Adults) 40 mg once daily (not to exceed 160 mg once daily); Addition of moderate CYP3A4 inhibitor to existing lurasidone therapy—↓ lurasidone dose by 50%; Addition of lurasidone to existing moderate CYP3A4 inhibitor therapy—20 mg once daily (not to exceed 80 mg once daily).

Renal Impairment

Oral (Adults) CCr <50 mL/min—20 mg once daily (not to exceed 80 mg once daily).

Hepatic Impairment

Oral (Adults) Child-Pugh Class B—20 mg once daily (not to exceed 80 mg once daily); Child-Pugh Class C—20 mg once daily (not to exceed 40 mg once daily).

Depressive Episodes Associated with Bipolar I Disorder

Oral (Adults) 20 mg once daily (not to exceed 120 mg once daily); Addition of moderate CYP3A4 inhibitor to existing lurasidone therapy—↓ lurasidone dose by 50%; Addition of lurasidone to existing moderate CYP3A4 inhibitor therapy—20 mg once daily (not to exceed 80 mg once daily).

Renal Impairment

Oral (Adults) CCr <50 mL/min—20 mg once daily (not to exceed 80 mg once daily).

Hepatic Impairment

Oral (Adults) Child-Pugh Class B—20 mg once daily (not to exceed 80 mg once daily); Child-Pugh Class C—20 mg once daily (not to exceed 40 mg once daily).

Availability

Tablets : 20 mg, 40 mg, 60 mg, 80 mg, 120 mg

Nursing implications

Nursing assessment

  • Monitor patient’s mental status (orientation, mood, behavior) before and periodically during therapy.
  • Assess weight and BMI initially and throughout therapy.
  • Monitor mood changes. Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient.
  • Monitor BP (sitting, standing, lying down) and pulse before and frequently during initial dose titration. May cause tachycardia and orthostatic hypotension. If hypotension occurs, dose may need to be ↓.
  • Observe patient when administering medication to ensure medication is swallowed and not hoarded or cheeked.
  • Monitor patient for onset of extrapyramidal side effects (akathisia—restlessness; dystonia—muscle spasms and twisting motions; or pseudoparkinsonism—mask-like face, rigidity, tremors, drooling, shuffling gait, dysphagia). Report these symptoms; reduction of dose or discontinuation may be necessary. Trihexyphenidyl or benztropine may be used to control symptoms.
  • Monitor for tardive dyskinesia (involuntary rhythmic movement of mouth, face, and extremities). Report immediately; may be irreversible.
  • Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness). Notify health care professional immediately if these symptoms occur.
  • Monitor for symptoms of hyperglycemia (polydipsia, polyuria, polyphagia, weakness) periodically during therapy.
  • Lab Test Considerations: May cause ↑ serum prolactin levels.
    • May cause ↑ CPK.
    • Obtain fasting blood glucose and cholesterol levels initially and periodically during therapy.
    • Monitor CBC frequently during initial mo of therapy in patients with pre-existing or history of low WBC. May cause leukopenia, neutropenia, or agranulocytosis. Discontinue therapy if this occurs.

Potential Nursing Diagnoses

Risk for self-directed violence (Indications)
Disturbed thought process (Indications)
Risk for injury (Side Effects)

Implementation

  • Oral: Administer once daily with food of at least 350 calories.

Patient/Family Teaching

  • Instruct patient to take medication as directed. Emphasize the caloric food needs for taking medication.
  • Inform patient of the possibility of extrapyramidal symptoms. Instruct patient to report these symptoms immediately to health care professional.
  • Advise patient to change positions slowly to minimize orthostatic hypotension.
  • May cause drowsiness and cognitive and motor impairment. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme ↑ in activity and talking, other unusual changes in behavior or mood occur.
  • Advise patient to avoid extremes in temperature; this drug impairs body temperature regulation.
  • Advise patient to tell health care professional what medications they are taking and to avoid taking new Rx, OTC, vitamins, or herbal products without consulting health care professional, especially alcohol and other CNS depressants.
  • Advise female patients to notify health care professional if pregnancy is planned or suspected, or if breast feeding or planning to breast feed.
  • Advise patient to notify health care professional of medication regimen before treatment or surgery.
  • Instruct patient to notify health care professional promptly if sore throat, fever, unusual bleeding or bruising, rash, or tremors occur.
  • Emphasize the importance of routine follow up exams to monitor side effects and continued participation in psychotherapy to improve coping skills.

Evaluation/Desired Outcomes

  • ↓ in symptoms of schizophrenia (delusions, hallucinations, social withdrawal, flat, blunted affects).
References in periodicals archive ?
Similarly, lurasidone treatment resulted in significantly greater endpoint reduction in Clinical Global Impressions--Bipolar Scale depression severity scores for both the 20- to 60-mg/day group (-1.
Atypical antipsychotics also include medications such as dozapine (Clozaril), ziprasidone (Geodon), paliperidone (Invega), quetiapine (Seroquel), asenapine (Saphris), lurasidone (Latuda), and iloperidone (Fanapt).
approval for its lurasidone schizophrenia treatment next year, and the company has a sales force of more than 1,000 that Dainippon wants to acquire, Nikkei said.
The analyses suggest that lurasidone is associated with reduced hostility in patients with schizophrenia and reduced frequency of certain adverse events commonly associated with antipsychotic treatment.
The antipsychotic, lurasidone (Latuda; B) is indicated for schizophrenia.
1139: Effects of Lurasidone on Hostility in Patients with an Acute Exacerbation of Schizophrenia: A Pooled Post-Hoc Analysis of 5 Short-Term Studies (Oral Presentation on Tuesday 31 March from 15:27-15:36 in Hall L8)
In addition, you will find news articles about lurasidone, the most recent drug approved for treating bipolar depression, and armodafinil, a sleep drug that is showing efficacy for the depressive component of this vexing disorder.
Those drugs include aripiprazole (Abilify), clozapine (Clozaril), ziprasidone (Geodon), paliperidone (Invega), risperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa), asenapine (Saphris), and lurasidone (Latuda).
Introduces method to help assess medication adherence in patients prescribed lurasidone (Latuda)
061]: 'Effect of lurasidone or risperidone on metabolic syndrome status in patients with schizophrenia: a post hoc analysis of a long-term study'
The approval, which came over the summer, was made for lurasidone as monotherapy and adjunctive therapy with lithium or valproate.