lurasidone
lurasidone
(loo-ras-i-done) lurasidone,Latuda
(trade name)Classification
Therapeutic: antipsychoticsPharmacologic: benzoisothiazole
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | unknown | 1–3 hr* | 24 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- neuroleptic malignant syndrome
- seizures
- suicidal thoughts
- akathisia (most frequent)
- drowsiness (most frequent)
- parkinsonism (most frequent)
- agitation
- anxiety
- cognitive/motor impairment
- dizziness
- dystonia
- tardive dyskinesia
Ear, Eye, Nose, Throat
- blurred vision
Cardiovascular
- bradycardia
- orthostatic hypotension
- syncope
- tachycardia
Gastrointestinal
- nausea (most frequent)
- esophageal dysmotility
Dermatologic
- pruritus
- rash
Endocrinologic
- hyperglycemia
- hyperprolactinemia
Hematologic
- agranulocytosis (life-threatening)
- anemia
- leukopenia
Metabolic
- dyslipidemia
- weight gain
Interactions
Drug-Drug interaction
Strong CYP3A4 inhibitors, including ketoconazole, clarithromycin, ritonavir, and voriconazole ↑ blood levels and risk of adverse reactions; concurrent use contraindicated.Strong CYP3A4 inducers, including rifampin, phenytoin, and carbamazepine ↓ blood levels and effectiveness; concurrent use contraindicated.Moderate inhibitors of the CYP3A4 enzyme system, including diltiazem, atazanavir, erythromycin, fluconazole, and verapamil ↑ blood levels; if used concurrently, dose of lurasidone should not exceed 40 mg/day.↑ sedation may occur with other CNS depressants, including alcohol, sedative/hypnotics, opioids, some antidepressants and antihistamines.St. John's wort ↓ blood levels and effectiveness; concurrent use contraindicatedGrapefruit juice ↑ blood levels and risk of adverse reactions; concurrent use contraindicatedRoute/Dosage
Schizophrenia
Renal Impairment
Oral (Adults) CCr <50 mL/min—20 mg once daily (not to exceed 80 mg once daily).Hepatic Impairment
Oral (Adults) Child-Pugh Class B—20 mg once daily (not to exceed 80 mg once daily); Child-Pugh Class C—20 mg once daily (not to exceed 40 mg once daily).Depressive Episodes Associated with Bipolar I Disorder
Renal Impairment
Oral (Adults) CCr <50 mL/min—20 mg once daily (not to exceed 80 mg once daily).Hepatic Impairment
Oral (Adults) Child-Pugh Class B—20 mg once daily (not to exceed 80 mg once daily); Child-Pugh Class C—20 mg once daily (not to exceed 40 mg once daily).Availability
Nursing implications
Nursing assessment
- Monitor patient’s mental status (orientation, mood, behavior) before and periodically during therapy.
- Assess weight and BMI initially and throughout therapy.
- Monitor mood changes. Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient.
- Monitor BP (sitting, standing, lying down) and pulse before and frequently during initial dose titration. May cause tachycardia and orthostatic hypotension. If hypotension occurs, dose may need to be ↓.
- Observe patient when administering medication to ensure medication is swallowed and not hoarded or cheeked.
- Monitor patient for onset of extrapyramidal side effects (akathisia—restlessness; dystonia—muscle spasms and twisting motions; or pseudoparkinsonism—mask-like face, rigidity, tremors, drooling, shuffling gait, dysphagia). Report these symptoms; reduction of dose or discontinuation may be necessary. Trihexyphenidyl or benztropine may be used to control symptoms.
- Monitor for tardive dyskinesia (involuntary rhythmic movement of mouth, face, and extremities). Report immediately; may be irreversible.
- Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness). Notify health care professional immediately if these symptoms occur.
- Monitor for symptoms of hyperglycemia (polydipsia, polyuria, polyphagia, weakness) periodically during therapy.
- Lab Test Considerations: May cause ↑ serum prolactin levels.
- May cause ↑ CPK.
- Obtain fasting blood glucose and cholesterol levels initially and periodically during therapy.
- Monitor CBC frequently during initial mo of therapy in patients with pre-existing or history of low WBC. May cause leukopenia, neutropenia, or agranulocytosis. Discontinue therapy if this occurs.
Potential Nursing Diagnoses
Risk for self-directed violence (Indications)Disturbed thought process (Indications)
Risk for injury (Side Effects)
Implementation
- Oral: Administer once daily with food of at least 350 calories.
Patient/Family Teaching
- Instruct patient to take medication as directed. Emphasize the caloric food needs for taking medication.
- Inform patient of the possibility of extrapyramidal symptoms. Instruct patient to report these symptoms immediately to health care professional.
- Advise patient to change positions slowly to minimize orthostatic hypotension.
- May cause drowsiness and cognitive and motor impairment. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
- Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme ↑ in activity and talking, other unusual changes in behavior or mood occur.
- Advise patient to avoid extremes in temperature; this drug impairs body temperature regulation.
- Advise patient to tell health care professional what medications they are taking and to avoid taking new Rx, OTC, vitamins, or herbal products without consulting health care professional, especially alcohol and other CNS depressants.
- Advise female patients to notify health care professional if pregnancy is planned or suspected, or if breast feeding or planning to breast feed.
- Advise patient to notify health care professional of medication regimen before treatment or surgery.
- Instruct patient to notify health care professional promptly if sore throat, fever, unusual bleeding or bruising, rash, or tremors occur.
- Emphasize the importance of routine follow up exams to monitor side effects and continued participation in psychotherapy to improve coping skills.
Evaluation/Desired Outcomes
- ↓ in symptoms of schizophrenia (delusions, hallucinations, social withdrawal, flat, blunted affects).