Formulary
Lurasidone hydrochloride: Indications, Dosing, Side Effects and Interactions
Lurasidone is a dopamine D 2 , 5-HT 2A , 5-HT 7 , alpha 2A - and alpha 2C - adrenoceptor antagonist, and is a partial agonist at 5-HT 1a receptors.
MedNext Academy | 5 min read
Lurasidone hydrochloride: Indications, Dosing, Side Effects and Interactions
Lurasidone is a dopamine D 2 , 5-HT 2A , 5-HT 7 , alpha 2A - and alpha 2C - adrenoceptor antagonist, and is a partial agonist at 5-HT 1a receptors.
Drug action
Lurasidone is a dopamine D 2 , 5-HT 2A , 5-HT 7 , alpha 2A - and alpha 2C - adrenoceptor antagonist, and is a partial agonist at 5-HT 1a receptors.
Indications and dose
**Schizophrenia**
- **Adult** (By Mouth): Initially 37 mg once daily, increased if necessary up to 148 mg once daily, for advice on restarting treatment following interruption-consult product literature.
**Schizophrenia [when given with moderate CYP3A4 inhibitors (e.g. diltiazem, erythromycin, fluconazole, and verapamil)]**
- **Adult** (By Mouth): Initially 18.5 mg once daily (max. per dose 74 mg once daily).
**Schizophrenia for lurasidone hydrochloride**
- **Child 13-17 years** (By mouth): Initially 37 mg once daily, increased if necessary up to 74 mg once daily, treatment should be prescribed by a specialist.
**Schizophrenia [when given with moderate CYP3A4 inhibitors (e.g. diltiazem, erythromycin, fluconazole, and verapamil)] for lurasidone hydrochloride**
- **Child 13-17 years** (By mouth): Initially 18.5 mg once daily (max. per dose 74 mg once daily), treatment should be prescribed by a specialist.
Cautions
For all antipsychotic drugs Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes (may raise blood glucose); epilepsy; history of jaundice; myasthenia gravis; Parkinson's disease (may be exacerbated); photosensitisation (may occur with higher dosages); prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma Cautions, further information Cardiovascular disease An ECG may be required, particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: for all antipsychotics (other than quetiapine and clozapine) in patients with parkinsonism or Lewy Body Disease (risk of severe extrapyramidal symptoms) in behavioural and psychological symptoms of dementia (BPSD), unless symptoms are severe and other non-pharmacological treatments have failed (increased risk of stroke) for use as a hypnotic, unless sleep disorder is due to psychosis or dementia (risk of confusion, hypotension, extrapyramidal side-effects, and falls) in patients prone to falls (may cause gait dyspraxia, parkinsonism) if prescribed a phenothiazine (other than prochlorperazine for nausea, vomiting, or vertigo; chlorpromazine for relief of persistent hiccups; levomepromazine as an antiemetic in palliative care) as first-line treatment (sedative, significant antimuscarinic (anticholinergic) toxicity in older people, and safer and more efficacious alternatives exist) if prescribed an antipsychotic drug with moderate or marked antimuscarinic effects (e.g. chlorpromazine, clozapine, flupenthixol, fluphenazine, pipothiazine, promazine, and zuclopenthixol) in patients with a history of prostatism or urinary retention (high risk of urinary retention) Cautions For lurasidone hydrochloride High doses in elderly; susceptibility to QT-interval prolongation
Side effects
For all antipsychotic drugs Common or very common Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; fatigue; galactorrhoea; gynaecomastia; hyperglycaemia; hyperprolactinaemia; hypersalivation; hypotension (dose-related); insomnia; leucopenia; movement disorders; muscle rigidity; neutropenia; parkinsonism; postural hypotension (dose-related); QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased Uncommon Agranulocytosis; confusion; neuroleptic malignant syndrome (discontinue-potentially fatal) Rare or very rare Sudden death; withdrawal syndrome neonatal Side-effects, further information For depot antipsychotics-side-effects may persist until the drug has been cleared from its depot site. Overdose Phenothiazines cause less depression of consciousness and respiration than other sedatives. Hypotension, hypothermia, sinus tachycardia, and arrhythmias may complicate poisoning. For details on the management of poisoning see Antipsychotics under Emergency treatment of poisoning . Side-effects For lurasidone hydrochloride Common or very common Anxiety; drooling; gastrointestinal discomfort; hypersensitivity; musculoskeletal stiffness; nausea; oculogyric crisis; pain; pruritus; psychiatric disorders; sleep disorders; tongue spasm Uncommon Appetite decreased; dysarthria; dysuria; gait abnormal; gastrointestinal disorders; hot flush; hyperhidrosis; hypertension; hyponatraemia; joint stiffness; myalgia; nasopharyngitis; vision blurred Rare or very rare Angioedema; eosinophilia; rhabdomyolysis Frequency not known Anaemia; angina pectoris; atrioventricular block; breast abnormalities; diarrhoea; dysmenorrhoea; dysphagia; renal failure; Stevens-Johnson syndrome; suicidal behaviour; vertigo
Interactions
**Severe interactions:**
- Latuda should be used cautiously when co-administered with other serotonergic agents, such as buprenorphine/opioids, MAO inhibitors, selective serotonin re-uptake inhibitors (SSRIs), serotonin...
**Other interactions (22):**
- Pharmacodynamic interactions Given the primary central nervous system effects of lurasidone, lurasidone should be used with caution in combination with other centrally acting medicinal products and...
- Caution is advised when prescribing lurasidone with medicinal products known to prolong the QT interval, e.g.
- Pharmacokinetic interactions The concomitant administration of lurasidone and grapefruit juice has not been assessed.
- Grapefruit juice inhibits CYP3A4 and may increase the serum concentration of lurasidone.
- Grapefruit juice should be avoided during treatment with lurasidone.
- Potential for other medicinal products to affect lurasidone Lurasidone and its active metabolite ID-14283 both contribute to the pharmacodynamic effect at the dopaminergic and serotonergic receptors.
Pregnancy
For all antipsychotic drugs Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. Pregnancy For lurasidone hydrochloride Use only if potential benefit outweighs risk-limited information available. M
Breast feeding
For all antipsychotic drugs There is limited information available on the short- and long-term effects of antipsychotic drugs on the breast-fed infant. Animal studies indicate possible adverse effects of antipsychotic medicines on the developing nervous system. Chronic treatment with antipsychotic drugs whilst breast-feeding should be avoided unless absolutely necessary. Phenothiazine derivatives are sometimes used in breast-feeding women for short-term treatment of nausea and vomiting. Breast feeding For lurasidone hydrochloride Use only if potential benefit outweighs risk-present in milk in animal studies. M
Hepatic impairment
Manufacturer advises caution in moderate to severe impairment (risk of increased exposure). Dose adjustments Manufacturer advises initially 18.5 mg once daily in moderate to severe impairment, increased if necessary up to 74 mg once daily in moderate impairment, or up to max. 37 mg once daily in severe impairment.
Renal impairment
Use only if potential benefit outweighs risk if creatinine clearance less than 15 mL/minute. M Dose adjustments Initially 18.5 mg once daily, up to max. 74 mg once daily if creatinine clearance less than 50 mL/minute, M see Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
Inside MedNext for this topic
- 411 MedNext-authored chapters
- 80,000+ MCQ bank
- 15 study modes
- Growing visual cheat sheets
Study modes
- Notes
- MCQ
- Audio
- Video
- Visual
- 3D Anatomy
- Trace
- Flashcards
- Mnemonics
- Image Bank
- Clinical
- Microscopy
- Audio QBank
- Cadaver
- Book Match
Continue reading
Subject HubPharmacology Hub
All pharmacology resources in one place.
Drug SchedulesIndian Drug Schedules
Schedule H, H1, X and G classifications.
FormularyBrowse all drugs
Search 1,850+ drug profiles.
Study Lurasidone hydrochloride in the MedNext app
Challenge yourself with targeted pharmacology MCQs on this drug class. Every explanation links back to the chapter that teaches the concept.
Start drug challengeExplore the full formulary