Lurasidone

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Lurasidone
Lurasidone.svg
Ball-and-stick model of the lurasidone molecule
Systematic (IUPAC) name
(3aR,4S,7R,7aS)-2-{(1R,2R)-2-[4-(1,2-benzisothiazol-3-yl)piperazin-1-ylmethyl] cyclohexylmethyl}hexahydro-4,7-methano-2H-isoindole-1,3-dione
Clinical data
Trade names Latuda
AHFS/Drugs.com Consumer Drug Information
MedlinePlus a611016
Licence data US Daily Med:link
Pregnancy
category
  • AU: B1
  • US: B (No risk in non-human studies)
Legal status
Routes of
administration
Oral
Pharmacokinetic data
Bioavailability 9–19% (oral)[1]
Metabolism Hepatic (CYP3A4-mediated)[1]
Biological half-life 18 hours[1]
Excretion Faecal (~80%), renal (~9%)[1]
Identifiers
CAS Number 367514-87-2
ATC code N05AE05 (WHO)
PubChem CID: 213046
IUPHAR/BPS 7461
ChemSpider 184739
UNII 22IC88528T YesY
ChEBI CHEBI:70735 YesY
ChEMBL CHEMBL1237021
Synonyms SM-13,496
Chemical data
Formula C28H36N4O2S
Molecular mass 492.68 g/mol
  • C1CC[C@H]([C@@H](C1)CN2CCN(CC2)C3=NSC4=CC=CC=C43)CN5C(=O)[C@H]6[C@@H]7CC[C@@H](C7)[C@H]6C5=O
  • InChI=1S/C28H36N4O2S/c33-27-24-18-9-10-19(15-18)25(24)28(34)32(27)17-21-6-2-1-5-20(21)16-30-11-13-31(14-12-30)26-22-7-3-4-8-23(22)35-29-26/h3-4,7-8,18-21,24-25H,1-2,5-6,9-17H2/t18-,19+,20-,21-,24+,25-/m0/s1
  • Key:PQXKDMSYBGKCJA-CVTJIBDQSA-N

Lurasidone /lɜːr.ˈræ.sɪ.dn/ (trade name Latuda) is an atypical antipsychotic developed by Dainippon Sumitomo Pharma[2] and marketed by Sunovion in the USA. In the USA since 2013, it is also approved for the treatment of depressive episodes associated with bipolar I disorder as well as bipolar II disorder in adults when used alone or in combination with lithium, valproate, or lamotrigine.

Medical uses

Lurasidone is FDA approved for the treatment of schizophrenia since 2010[3] and depressive episodes associated with bipolar I disorder since 2013.[4] It received regulatory approval in the UK in September 2014. In October 2014, NHS Scotland advised use of lurasidone for schizophrenic adults who have not seen improvements with previous antipsychotics due to problems that arise from weight gain or changes in metabolic pathways when taking other medications.[5] It received EMA approval on January 24, 2014. It was launched in Canada for the treatment of schizophrenia in September 2012, Health Canada giving their Summary Basis of Decision (SBD) as favourable on October 15, 2012.[6] European Commission has granted a marketing authorization for once-daily oral lurasidone for the treatment of schizophrenia in adults.[7] It is approved for use in the EU.[8]

In July 2013 lurasidone received approval for bipolar I depression.[4] Few available atypical antipsychotics are known to possess antidepressant efficacy in bipolar disorder (with the notable exceptions being quetiapine,[9][10][11][12] olanzapine[13][14][15] and possibly asenapine[16]) as a monotherapy, even though the majority of atypical antipsychotics are known to possess significant antimanic activity,[17] which is yet to be clearly demonstrated for lurasidone.

Lurasidone may be useful for treating the cognitive and memory deficits seen in schizophrenia. In animal studies, it reversed dizocilpine-induced learning and memory impairment and was found to be superior in doing this to all of the other antipsychotics examined, including risperidone, olanzapine, quetiapine, clozapine, aripiprazole, and haloperidol.[18][19] Lurasidone has activity at several serotonin receptors that are involved in learning and memory, and unlike most other antipsychotics, lacks any anticholinergic effects (which are known to impair cognitive processes and memory).[18] These properties may underlie its improved effectiveness in treating these symptoms relative to older agents.[18]

Lurasidone has completed phase III clinical trial for extended use study in India,[20] although it is not yet approved in India.[21]

Lurasidone is not approved by the Food and Drug Administration (FDA) for the treatment of behavior disorders in older adults with dementia.

Contraindications

Lurasidone is contraindicated in individuals who are taking strong CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir, levodropropizine, etc.) or inducers (carbamazepine, St. John's wort, phenytoin, rifampicin etc.).[22] The use of lurasidone in pregnant women has not been studied and is not recommended, although it should be noted that it is a category B drug.[23] Excretion in breast milk is also unknown; lurasidone is not recommended for breastfeeding women.[24] In the United States it is not indicated for use in children.[25]

Adverse effects

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Side effects are generally similar to other antipsychotics. The drug has a relatively well-tolerated side effect profile, with low propensity for QTc interval changes, weight and lipid-related adverse effects.[26] In a recent meta-analysis of the efficacy and tolerability of 15 antipsychotic drugs it was found to produce the second least (after haloperidol) weight gain, the least QT interval prolongation, the fourth most extrapyramidal side effects (after haloperidol, zotepine and chlorpromazine) and the sixth least sedation (after paliperidone, sertindole, amisulpride, iloperidone and aripiprazole).[27]

As with other atypical neuroleptics, lurasidone should be used with caution in the elderly because it puts them at an increased risk for a stroke or transient ischemic attack;[28][29] however, these risks are not likely to be greater than those associated with antipsychotics of other classes.[30] Similarly, lurasidone should not be used to treat dementia-related psychosis, as evidence has shown increased mortality with antipsychotic use.[31]

Pharmacology

Mechanism of action

Lurasidone acts as an antagonist of the following sites:[18][32]

And as a partial agonist of the following sites:[18]

Lurasidone has negligible actions at the H1 and mACh receptors.[18]

Pharmacokinetics

Studies have shown that when lurasidone is taken with food, absorption increases.[33]

Lurasidone is metabolized in the liver via the enzyme CYP3A4.[28] This means that its plasma concentrations may be increased when combined with CYP3A4 inhibitors like ketoconazole or grapefruit juice, possibly leading to more side effects. Co-administration of CYP3A4 inducers like rifampicin or St. John's wort can reduce plasma levels and consequently decrease the effects of the drug.

References

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  4. 4.0 4.1 Lowes R. Lurasidone Approved for Bipolar Depression [Internet]. Medscape. 2013 [cited 2013 Oct 2]. Available from: http://www.medscape.com/viewarticle/807204
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  21. https://www.quora.com/Is-Latuda-drug-available-in-India
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  23. Pregnancy category
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  33. Latuda (lurasidone) [prescribing information]. Marlborough, MA: Sunovion Pharmaceuticals Inc.; July 2013.