Lurasidone – Psychopharmacology, Side Effects and Clinical Pearls

Posted on: August 23, 2020

Last Updated: November 19, 2021

Lurasidone is an Atypical antipsychotic / Second Generation antipsychotic which is metabolically friendly. It has D2-5HT2A antagonistic properties.

It also acts on the following receptors

1. 5HT-7 antagonism which gives it procognitive and antidepressant effect

2. Alpha 2 A and C antagonism – antidepressant properties

3. 5HT1A partial agonism – antidepressant properties

Side effects –

Akathisia should be carefully monitored for.

Pharmacokinetics:

Half-life of 18 hrs.
Metabolised by CYP3A4. Lurasidone is contraindicated with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, ritonavir, and voriconazole) and strong CYP3A4 inducers (e.g., rifampin, St. John’s wort, phenytoin, and carbamazepine)
Grapefruit and grapefruit juice should be avoided in patients taking Lurasidone, as these may inhibit CYP3A4.

Dose range : 40 mg – 160 mg.

Important pearls:

Switch from Olanzapine and Quetiapine should be done gradually to avoid antihistaminergic and anticholinergic rebound.
The dose should be given in the evening to minimise akathisia.
Useful as an augmentation agent to treat mixed features
Useful as an augmentation agent to treat psychotic depression or melancholic depression with agitation
Anecdotal case of a patient with severe treatment-resistant schizophrenia with lurasidone as an augmentation strategy with clozapine.
Lurasidone and Clozapine as an augmentation strategy.
Lurasidone and olanzapine combination in psychosis.