Nurses Compass
Drug Guide
Lumateperone
Classification
Therapeutic: Antipsychotic, atypical
Pharmacological: Serotonin dopamine antagonist
FDA Approved Indications
- Schizophrenia in adults
Mechanism of Action
Lumateperone acts as a serotonin 5-HT2A receptor antagonist and a dopamine D2 receptor modulator, which helps balance neurotransmitters involved in psychosis.
Dosage and Administration
Adult: 40 mg once daily, with or without food
Pediatric: Not approved for pediatric use
Geriatric: Use with caution, no specific dosage adjustment established
Renal Impairment: No specific adjustment needed, monitor closely
Hepatic Impairment: Use with caution, no specific adjustment established
Pharmacokinetics
Absorption: Well absorbed orally
Distribution: Extensively bound to plasma proteins
Metabolism: Primarily via CYP3A4 and CYP2D6 pathways
Excretion: Metabolites excreted mainly in feces and urine
Half Life: Approximately 18-21 hours
Contraindications
- Hypersensitivity to lumateperone or excipients
Precautions
- History of neuroleptic malignant syndrome, cardiovascular disease, seizures, or orthostatic hypotension. Use with caution during pregnancy and lactation.
Adverse Reactions - Common
- Drowsiness (Likely)
- Dry mouth (Common)
- Dizziness (Common)
- Weight gain (Less common)
Adverse Reactions - Serious
- Neuroleptic malignant syndrome (Rare)
- QT prolongation (Uncommon)
- Tardive dyskinesia (Rare)
- Suicide ideation (Monitor closely)
Drug-Drug Interactions
- CYP3A4 inhibitors (e.g., ketoconazole) may increase lumateperone levels, CYP3A4 inducers (e.g., rifampin) may decrease levels.
Drug-Food Interactions
- No significant interactions reported.
Drug-Herb Interactions
- Caution with st. john's wort and other serotonergic herbs due to risk of serotonin syndrome.
Nursing Implications
Assessment: Monitor mental status, mood, and behaviors; observe for extrapyramidal symptoms; baseline ECG in patients at risk for QT prolongation.
Diagnoses:
- Risk of falls due to dizziness or sedation.
- Risk for metabolic syndrome.
Implementation: Administer as prescribed, assess for adverse effects, monitor vital signs and mental status.
Evaluation: Evaluate therapeutic response and adverse effects periodically.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Do not stop abruptly.
- Avoid alcohol and CNS depressants.
- Report signs of allergic reactions, abnormal movements, or worsening mental health.
Special Considerations
Black Box Warnings:
- Increased risk of death in elderly patients with dementia-related psychosis.
- Suicidal thoughts and behaviors in young adults and adolescents.
Genetic Factors: No specific genetic testing indicated.
Lab Test Interference: None known.
Overdose Management
Signs/Symptoms: Severe drowsiness, agitation, hypotension, QT prolongation, lack of coordination.
Treatment: Supportive care, monitoring cardiac status, activated charcoal if ingestion is recent, none specific antidote.
Storage and Handling
Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).
Stability: Stable for shelf life conferred by manufacturer.