Lurasidone hydrochloride

How it works

It is an antagonist at dopamine D2 and serotonin 5-HT2A receptors with additional 5-HT7 antagonism and 5-HT1A partial agonism, an action associated with antipsychotic effect and a relatively low metabolic burden.

Prescribing in practice

• Lurasidone must be taken with food to achieve reliable absorption, and taking it without an adequate meal substantially reduces exposure and efficacy.
• It is metabolised by CYP3A4, so it is contraindicated with potent CYP3A4 inhibitors or inducers and requires dose adjustment with moderate inhibitors; monitor for akathisia, extrapyramidal symptoms and somnolence.
• As with all antipsychotics watch for neuroleptic malignant syndrome and avoid in the elderly with dementia-related psychosis owing to increased mortality, though metabolic and prolactin effects are generally less pronounced than with some alternatives.

Monitoring

Monitor mental state, movement disorders and akathisia, weight and metabolic parameters, and for signs of neuroleptic malignant syndrome.

Counselling the patient

• Always take this medicine with a substantial meal for it to work properly.
• Report restlessness, abnormal movements, muscle stiffness or fever.
• Tell your prescriber about other medicines, as some strongly affect lurasidone levels.

Evidence & guidelines

Regulatory approval and NICE-aligned practice support lurasidone for schizophrenia, with product information stressing administration with food for adequate absorption.