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Lurasidone

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{{Drugbox | IUPAC_name = (3aR,4S,7R,7aS)-2-[((1R,2R)-2-{[4-(1,2-benzisothiazol-3-yl)-piperazin-1-yl]methyl}cyclohexyl)methyl]hexahydro-1H-4,7-methanisoindol-1,3-dione | image = Lurasidone_structure.svg | width = 300 | image2 = Lurasidone 3D ball.png | width2 = 260 | alt2 = Ball-and-stick model of the lurasidone molecule

| tradename = Latuda | Drugs.com = Consumer Drug Information | MedlinePlus = a611016 | DailyMedID = 88a244d1-eddb-499c-bee2-e1f49056e78f | licence_US = Lurasidone | pregnancy_AU = B1 | pregnancy_US = B | pregnancy_category = | legal_AU = S4 | legal_CA = Rx-only | legal_US = Rx-only | legal_status = | routes_of_administration = Oral

| bioavailability = 9–19% (oral)[1] | metabolism = Hepatic (CYP3A4-mediated)[1] | elimination_half-life = 18 hours[1] | excretion = Faecal (~80%), renal (~9%)[1] | CAS_number = 367514-87-2 | ATC_prefix = N05 | ATC_suffix = AE05 | PubChem = 213046 | ChemSpiderID = 184739 | UNII_Ref =  checkY | UNII = 22IC88528T | ChEMBL = 1237021 | ChEBI_Ref =  checkY | ChEBI = 70735 | synonyms = SM-13,496

| C = 28 | H = 36 | N = 4 | O = 2 | S = 1 | molecular_weight = 492.676 g/mol | smiles = O=C1N(C(=O)[C@H]3[C@@H]1[C@@H]2CC[C@H]3C2)C[C@@H]4CCCC[C@H]4CN7CCN(c6nsc5ccccc56)CC7 | StdInChI=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 | StdInChIKey=PQXKDMSYBGKCJA-CVTJIBDQSA-N }}

Lurasidone /lɜːr.ˈræ.sɪ.doʊn/ (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 (bipolar depression) in adults when used alone or in combination with lithium or valproate.

Administration

Lurasidone should be administered orally with food (> 350 calories). Studies have shown that when lurasidone is taken with food, absorption increases.[3]

Medical uses

Lurasidone is FDA approved for the treatment of schizophrenia[4] and depressive episodes associated with bipolar I disorder.[5] It has received regulatory approval in the UK in September 2014. 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's approved for use in the EU.[8]

In July 2013 lurasidone received approval for bipolar I depression.[5] 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.[citation needed] Lurasidone is not approved by the Food and Drug Administration (FDA) for the treatment of behavior disorders in older adults with dementia.

Adverse effects

See also: List of adverse effects of lurasidone

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.[21] 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).[22]

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;[23][24] however, these risks are not likely to be greater than those associated with antipsychotics of other classes.[25] Similarly, lurasidone should not be used to treat dementia-related psychosis, as evidence has shown increased mortality with antipsychotic use.[26]

Pharmacology

Pharmacodynamics

Lurasidone acts as an antagonist of the following sites:[18][27]

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

Note: All values are rounded to the nearest tenth.

It has only weak or negligible actions at the H1, and mACh receptors.[18]

Pharmacokinetics

Lurasidone is metabolized in the liver via the enzyme CYP3A4.[23] 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.

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.).[28] The use of lurasidone in pregnant women has not been studied and is not recommended. Excretion in breast milk is also unknown; lurasidone is not recommended for breastfeeding women.[29] Additionally and as with other antidepressants, lurasidone increases the risk of suicidal thinking and behavior in patients 18 to 24 years old. In the United States it is not indicated for use in children.[30]

References

  1. ^ a b c d "PRODUCT INFORMATION LATUDA (lurasidone hydrochloride)" (PDF). TGA eBusiness Services. Therapeutic Goods Administration. 16 April 2014. Retrieved 1 May 2014.
  2. ^ Meyer, Jonathan M; Loebel, Antony D; Schweizer, Edward (2009). "Lurasidone: A new drug in development for schizophrenia". Expert Opinion on Investigational Drugs. 18 (11): 1715–26. doi:10.1517/13543780903286388. PMID 19780705.
  3. ^ Latuda (lurasidone) [prescribing information]. Marlborough, MA: Sunovion Pharmaceuticals Inc.; July 2013.
  4. ^ "FDA approves Latuda to treat schizophrenia in adults" (Press release). USFDA. 2010-10-28. Retrieved October 29, 2010.
  5. ^ a b Lowes R. Lurasidone Approved for Bipolar Depression [Internet]. Medscape. 2013 [cited 2013 Oct 2]. Available from: http://www.medscape.com/viewarticle/807204
  6. ^ http://www.hc-sc.gc.ca/dhp-mps/prodpharma/sbd-smd/drug-med/sbd_smd_2012_latuda_145406-eng.php#a2 Health Canada Summary Basis of Decision (SBD) for PrLATUDA™
  7. ^ http://www.tpi.takeda.com/media/news-releases/2014/european-marketing-authorization-for-latuda/
  8. ^ http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/002713/human_med_001737.jsp&mid=WC0b01ac058001d124
  9. ^ Young, Allan H.; McElroy, Susan L.; Bauer, Michael; Philips, Nabil; Chang, William; Olausson, Bengt; Paulsson, Björn; Brecher, Martin; EMBOLDEN I (Trial 001) Investigators (2010). "A Double-Blind, Placebo-Controlled Study of Quetiapine and Lithium Monotherapy in Adults in the Acute Phase of Bipolar Depression (EMBOLDEN I)". The Journal of Clinical Psychiatry. 71 (2): 150–62. doi:10.4088/JCP.08m04995gre. PMID 20122369.{{cite journal}}: CS1 maint: numeric names: authors list (link)
  10. ^ Suppes, Trisha; Datto, Catherine; Minkwitz, Margaret; Nordenhem, Arvid; Walker, Chris; Darko, Denis (2010). "Effectiveness of the extended release formulation of quetiapine as monotherapy for the treatment of acute bipolar depression". Journal of Affective Disorders. 121 (1–2): 106–15. doi:10.1016/j.jad.2009.10.007. PMID 19903574.
  11. ^ "Corrigendum". Bipolar Disorders. 10 (3): 451. 2008. doi:10.1111/j.1399-5618.2008.00585.x.
  12. ^ Thase, ME (2008). "Quetiapine monotherapy for bipolar depression". Neuropsychiatric disease and treatment. 4 (1): 11–21. doi:10.2147/ndt.s1162. PMC 2515925. PMID 18728771.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  13. ^ Tohen, Mauricio; Vieta, E; Calabrese, J; Ketter, TA; Sachs, G; Bowden, C; Mitchell, PB; Centorrino, F; Risser, R; Baker, RW; Evans, AR; Beymer, K; Dube, S; Tollefson, GD; Breier, A (2003). "Efficacy of Olanzapine and Olanzapine-Fluoxetine Combination in the Treatment of Bipolar I Depression". Archives of General Psychiatry. 60 (11): 1079–88. doi:10.1001/archpsyc.60.11.1079. PMID 14609883.
  14. ^ Tohen, M.; Katagiri, H.; Fujikoshi, S.; Kanba, S. (2013). "Efficacy of olanzapine monotherapy in acute bipolar depression: A pooled analysis of controlled studies". Journal of Affective Disorders. 149 (1–3): 196–201. doi:10.1016/j.jad.2013.01.022. PMID 23485111.
  15. ^ Corya, Sara A.; Perlis, Roy H.; Keck Jr, Paul E.; Lin, Daniel Y.; Case, Michael G.; Williamson, Doug J.; Tohen, Mauricio F. (2006). "A 24-Week Open-Label Extension Study of Olanzapine-Fluoxetine Combination and Olanzapine Monotherapy in the Treatment of Bipolar Depression". The Journal of Clinical Psychiatry. 67 (5): 798–806. doi:10.4088/JCP.v67n0514. PMID 16841630.
  16. ^ Azorin, J.M.; Sapin, C.; Weiller, E. (2013). "Effect of asenapine on manic and depressive symptoms in bipolar I patients with mixed episodes: Results from post hoc analyses". Journal of Affective Disorders. 145 (1): 62–9. doi:10.1016/j.jad.2012.07.013. PMID 22868059.
  17. ^ Cipriani, Andrea; Barbui, Corrado; Salanti, Georgia; Rendell, Jennifer; Brown, Rachel; Stockton, Sarah; Purgato, Marianna; Spineli, Loukia M; Goodwin, Guy M; Geddes, John R (2011). "Comparative efficacy and acceptability of antimanic drugs in acute mania: A multiple-treatments meta-analysis". The Lancet. 378 (9799): 1306–15. doi:10.1016/S0140-6736(11)60873-8. PMID 21851976.
  18. ^ a b c d e f Ishiyama, Takeo; Tokuda, Kumiko; Ishibashi, Tadashi; Ito, Akira; Toma, Satoko; Ohno, Yukihiro (2007). "Lurasidone (SM-13496), a novel atypical antipsychotic drug, reverses MK-801-induced impairment of learning and memory in the rat passive-avoidance test". European Journal of Pharmacology. 572 (2–3): 160–70. doi:10.1016/j.ejphar.2007.06.058. PMID 17662268.
  19. ^ Enomoto, T; Ishibashi, T; Tokuda, K; Ishiyama, T; Toma, S; Ito, A (2008). "Lurasidone reverses MK-801-induced impairment of learning and memory in the Morris water maze and radial-arm maze tests in rats". Behavioural Brain Research. 186 (2): 197–207. doi:10.1016/j.bbr.2007.08.012. PMID 17881065.
  20. ^ "Lurasidone Extended Use Study". ClinicalTrials.gov.
  21. ^ Dainippon Sumitomo Pharma (August 26, 2009). "Lurasidone Demonstrated Efficacy in Treating Patients with Schizophrenia in Pivotal Phase III Study" (PDF).[dead link‍]
  22. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 23810019, please use {{cite journal}} with |pmid=23810019 instead.
  23. ^ a b "Latuda: Prescribing Information". Psychotherapeutic Drugs. Retrieved 2010-12-17.
  24. ^ "Latuda". Drugs.com. Retrieved 2010-12-17.
  25. ^ Herrmann, N.; Mamdani, M; Lanctôt, KL (2004). "Atypical Antipsychotics and Risk of Cerebrovascular Accidents". American Journal of Psychiatry. 161 (6): 1113–5. doi:10.1176/appi.ajp.161.6.1113. PMID 15169702.
  26. ^ Sunovion Pharmaceuticals. "Latuda Prescribing Information" (PDF). Latuda.com. Retrieved 25 March 2014.
  27. ^ Ishibashi, T.; Horisawa, T.; Tokuda, K.; Ishiyama, T.; Ogasa, M.; Tagashira, R.; Matsumoto, K.; Nishikawa, H.; Ueda, Y.; Toma, S.; Oki, H.; Tanno, N.; Saji, I.; Ito, A.; Ohno, Y.; Nakamura, M. (2010). "Pharmacological Profile of Lurasidone, a Novel Antipsychotic Agent with Potent 5-Hydroxytryptamine 7 (5-HT7) and 5-HT1A Receptor Activity". Journal of Pharmacology and Experimental Therapeutics. 334 (1): 171–81. doi:10.1124/jpet.110.167346. PMID 20404009.
  28. ^ . PMID 24825095. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  29. ^ . PMID 18378767. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  30. ^ . PMID 21459738. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
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