Second Generation (Atypical) Antipsychotic
“ALERT: US Boxed Warning
Increased mortality in elderly patients with dementia-related psychosis:
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Lurasidone is not approved for the treatment of patients with dementia-related psychosis.
Suicidal thoughts and behaviors:
Antidepressants increased the risk of suicidal thoughts and behavior in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and for the emergence of suicidal thoughts and behaviors.”
How Does It Work
Lurasidone, Latuda is an atypical antipsychotic that has a 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. It does not bind muscarinic M1 and histamine H1 receptors. The addition of serotonin antagonism to dopamine antagonism is thought to improve negative symptoms of psychoses and reduce the incidence of extrapyramidal side effects as compared to typical antipsychotics.
Indications For Use
Bipolar major depression, Schizophrenia
Before starting Lurasidone, Latuda makes sure your physician is aware of any allergies or medications you currently take, if you have cardiovascular disease, dementia, hepatic impairment, renal impairment, a history of seizures, are pregnant, or breastfeeding. Suicidal ideation is inherent with bipolar disorder or psychotic illness so caution must be used and any major changes in personality or mood should be reported to the physician immediately. Lurasidone, Latuda use has been associate with adverse events such as altered cardiac conduction, blood dyscrasias, CNS depression, dyslipidemia, esophageal dysmotility/aspiration, extrapyramidal symptoms, increased risk of falls, hyperglycemia, hyperprolactinemia, neuroleptic malignant syndrome, orthostatic hypotension, temperature dysregulation, and weight gain.
Oral: 20-160 mg once daily in the evening within 30 minutes of food (≥350 calories); may increase the daily dose based on response and tolerability
Pharmacist Tips On Using
How to Take: Follow instructions provided by physician/pharmacy label and store at room temperature. Administer consistently at the same time every day with food (≥350 calories). Evening administration may help reduce adverse effects.
You Need to Avoid: Do not consume grapefruit/grapefruit juice while on this medication. Operating heavy machinery or driving at least until you know how the medication affects you. Do not stop this medication suddenly, make sure your physician is aware and can create a tapering schedule so you can come off slowly and prevent any withdrawal symptoms. This medication has many drug interactions so ask your pharmacist before starting any over-the-counter medications or supplements.
serum triglycerides, increased serum cholesterol, increased serum glucose, nausea, viral infection, extrapyramidal reaction, drowsiness, akathisia, parkinsonian-like syndrome
Note– this is not a complete list of side effects, only common ones, and are generally dosage-dependent. When higher doses are required the physician has weighed the risks and found the benefits to be greater, however regular monitoring (blood sugar, cholesterol, blood pressure, etc.) is important to make sure this does not change
Frequently Asked Questions
This medication has a lot of scary side effects, is it safe?
All medications have side effects however this medication works on a lot of different neurotransmitter receptors in the brain which can lead to a variety of intentional and unintentional effects. These are mostly dosage dependant and in lower doses the risk is minimal. In all cases, regular lab work will allow your physician to see if your blood sugar, cholesterol etc. start to move in the wrong direction so action can be taken before they become a problem.
What are extra-pyramidal reactions?
Blocking dopamine in the extra-pyramidal system in the central nervous system that regulates posture and skeletal muscle tone may cause a variety of movement disorders. This can include dystonic reactions (muscular spasms, usually repetitive), akathisia (motor restlessness/uneasiness), pseudoparkinsonism (drug induced Parkinsonism – tremor, rigidity, bradykinesia, etc.), tardive dyskinesia (involuntary complex muscle movements in lower face and extremities). These side effects are generally dose dependant and generally occur with long term use of medications that block dopamine. If any of these effects may be occurring, speak to your physician as soon as possible to discuss your options.
What is Neuroleptic Malignant Syndrome?
NMS is a rare but serious reaction from significant blockade of dopamine which can occur from antipsychotic medications or from being on high dosages of levodopa (dopamine analogue) and stopping suddenly. Presents initially as muscle cramps, tremors, fever, unstable blood pressure, and sudden changes in mental status. As it progresses over 8-40 hours it can lead to complications of rhabdomyolysis, hyperkalemia, kidney failure, or seizures. Seek medical attention immediately if this reaction is suspected.