Lurasidone

How it works

It is an antagonist at dopamine D2 and serotonin 5-HT2A receptors, with additional activity at 5-HT7, 5-HT1A and noradrenergic alpha-2 receptors.

Prescribing in practice

• Lurasidone should be taken with food to ensure adequate and reliable absorption, as bioavailability is substantially reduced when taken without food.
• It is metabolised by CYP3A4, so co-administration with strong CYP3A4 inhibitors or inducers is contraindicated or requires dose adjustment per the SPC.
• There is an increased risk of stroke and death in elderly patients with dementia-related psychosis, for which it is not indicated.

Monitoring

Monitor weight, blood glucose, lipids and for extrapyramidal symptoms or akathisia in keeping with standard antipsychotic monitoring.

Counselling the patient

• Always take this medicine with food to make sure it is absorbed properly.
• Avoid grapefruit and grapefruit juice while taking lurasidone.
• Report restlessness, abnormal movements or muscle stiffness to your healthcare team.

Evidence & guidelines

Lurasidone is licensed for schizophrenia on the basis of randomised controlled trials and is recommended within NICE guidance on the treatment of psychosis and schizophrenia.