Lumateperone

How it works

It modulates serotonergic, dopaminergic and glutamatergic neurotransmission, acting as a serotonin 5-HT2A receptor antagonist and a dopamine D2 receptor modulator with presynaptic partial agonist and postsynaptic antagonist activity.

Prescribing in practice

• As with all antipsychotics, there is an increased risk of stroke and death when used in elderly patients with dementia-related psychosis, and it is not licensed for this indication.
• Antipsychotics can prolong the QT interval, so caution is advised in patients with cardiac risk factors or those taking other QT-prolonging medicines.
• Exposure is altered by CYP3A4 inhibitors and inducers, so review concomitant interacting medicines.

Monitoring

Monitor metabolic parameters including weight, blood glucose and lipids, alongside cardiovascular status, in line with antipsychotic monitoring standards.

Counselling the patient

• May cause drowsiness; take care with driving or operating machinery until you know how it affects you.
• Report any abnormal movements, persistent fever, or muscle stiffness promptly.
• Do not stop the medicine suddenly without discussing it with your prescriber.

Evidence & guidelines

Lumateperone's efficacy in schizophrenia is supported by randomised placebo-controlled trials, and its use should follow the approved product information.