Nurses Compass
Drug Guide
Lurasidone Hydrochloride
Classification
Therapeutic: Antipsychotic, atypical
Pharmacological: Dopamine D2 and serotonin 5-HT2A receptor antagonist
FDA Approved Indications
- Schizophrenia in adults and adolescents (13 years and older)
- Depressive episodes associated with bipolar disorder (bipolar depression) in adults
Mechanism of Action
Lurasidone primarily exerts its effects through antagonism of dopamine D2 and serotonin 5-HT2A receptors, which helps balance neurotransmitters implicated in mood and thought disorders.
Dosage and Administration
Adult: Start with 40 mg once daily, with or without food. Adjust based on response and tolerability, typically up to 160 mg per day.
Pediatric: Not FDA approved for children under 13. For adolescents 13 and older, dosing similar to adult, starting at 40 mg once daily.
Geriatric: Use caution; start at lower end of dosing range and monitor closely.
Renal Impairment: No specific dose adjustment recommended for mild to moderate impairment; use caution in severe impairment.
Hepatic Impairment: Start at lower doses; monitor for adverse effects; specific dosing guidance not established.
Pharmacokinetics
Absorption: Well absorbed with food; absorption significantly increases when taken with meals (≥350 kcal).
Distribution: High protein binding (~99%).
Metabolism: Primarily via CYP3A4 enzyme; minimal CYP2D6 metabolism.
Excretion: Excreted mainly in feces; minor renal excretion.
Half Life: Approximately 18-26 hours, supporting once-daily dosing.
Contraindications
- Hypersensitivity to lurasidone or any component of the formulation.
Precautions
- Use with caution in patients with a history of seizures, cardiovascular disease, or QT prolongation. May increase risk of EPS and metabolic changes. Watch for neuroleptic malignant syndrome. Avoid use in combination with other drugs that prolong QT interval.
Adverse Reactions - Common
- Akathisia (Common)
- Drowsiness (Common)
- Nausea (Common)
- Extrapyramidal symptoms (Less common)
- Weight gain (Less common)
Adverse Reactions - Serious
- QT prolongation, Torsades de Pointes (Rare)
- Neuroleptic malignant syndrome (Rare)
- Severe hypersensitivity reactions (Rare)
Drug-Drug Interactions
- CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) - increase lurasidone levels
- CYP3A4 inducers (e.g., rifampin, carbamazepine) - decrease effectiveness
Drug-Food Interactions
- High-fat or high-calorie meals significantly increase absorption.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for therapeutic response, side effects including EPS, metabolic parameters, and QT interval.
Diagnoses:
- Risk for falls due to dizziness or sedation
- Risk for metabolic syndrome
Implementation: Administer with or without food; advise patient to take consistently. Monitor for signs of tardive dyskinesia and metabolic changes.
Evaluation: Assess symptom control, monitor side effects, and laboratory parameters.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report any signs of movement disorders, agitation, or changes in mood.
- Avoid alcohol and CNS depressants.
- Be cautious about activities requiring alertness until effects are known.
Special Considerations
Black Box Warnings:
- Increased mortality in elderly patients with dementia-related psychosis.
Genetic Factors: Consider CYP3A4 genotype testing if adverse effects or unusual responses occur.
Lab Test Interference: May cause slight increases in prolactin levels; monitor as clinically indicated.
Overdose Management
Signs/Symptoms: Somnolence, sedation, agitation, extrapyramidal symptoms, orthostatic hypotension, QT prolongation.
Treatment: Supportive care, monitored cardiac rhythm, activated charcoal if ingestion recent, no specific antidote.
Storage and Handling
Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).
Stability: Stable under recommended storage conditions.