lurasidone hydrochloride: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
lurasidone hydrochloride: clinical details
Prescribing considerations
- Confirm the licensed indication and arrange specialist involvement for adolescent treatment.
- Review all prescribed, non-prescribed and herbal products for CYP3A4 interactions before initiation and whenever treatment changes.
- Assess renal and hepatic function because impairment increases exposure.
- Use caution with cardiovascular disease, QT-risk factors, seizures, Parkinson’s disease, vulnerability to hypotension and dementia-related stroke risk.
- Assess venous-thromboembolism risk and suicidality.
- Switching from another antipsychotic requires clinical supervision.
Contraindications and cautions
- Hypersensitivity to lurasidone or an excipient.
- Concurrent strong CYP3A4 inhibitors.
- Concurrent strong CYP3A4 inducers.
Monitoring
- Clinical response, adherence and suicidality, especially after starting or switching treatment.
- Akathisia, parkinsonism, dystonia and tardive dyskinesia.
- Weight and clinically appropriate metabolic measures, particularly where diabetes risk exists.
- Symptoms of prolactin elevation, including menstrual, breast or sexual effects.
- Blood pressure, including postural measurements when relevant.
- Cardiac assessment where cardiovascular disease, electrolyte disturbance, family history or interacting medicines create QT risk.
- Renal and hepatic function where clinically indicated.
Clinical pharmacology
Lurasidone antagonises dopamine D2, serotonin 5-HT2A and 5-HT7 receptors and alpha-2 adrenergic receptors, with partial agonism at 5-HT1A receptors. It is highly protein-bound, principally metabolised through CYP3A4 and has active metabolites.
Formulation and product differences
- The selected product is a film-coated oral tablet intended to be swallowed whole.
- The selected tablet is white, circular and convex with a minus-sign marking.
- Tablet appearance, markings, excipients and packaging can differ between manufacturers; verify the exact product leaflet when switching.
lurasidone hydrochloride preparations and strengths
Tablet
Route: Oral
Strengths: 18.5 mg, 37 mg, 74 mg
lurasidone hydrochloride interactions
Lurasidone is mainly metabolised by CYP3A4, creating several clinically important interactions.
Strong CYP3A4 inhibitors, including clarithromycin, itraconazole, ketoconazole, posaconazole, voriconazole and ritonavir
These can greatly increase lurasidone exposure and are contraindicated.
Strong CYP3A4 inducers, including carbamazepine, phenytoin, phenobarbital, rifampicin and St John’s wort
These can greatly reduce lurasidone exposure and are contraindicated.
Diltiazem, erythromycin, fluconazole and verapamil
These may increase lurasidone exposure and require prescriber review.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.