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Depressive Phase of Bipolar Disorder
Published in Dr. Ather Muneer, Mood Disorders, 2018
Lurasidone, another SGA, is unique in that it has FDA approval for the treatment of MDE in BD type I, but so far is not licensed for use in manic or mixed episodes. This endorsement is based on two pivotal internationally conducted RCTs in which lurasidone showed superiority over placebo both as monotherapy and as an adjunct to lithium and valproate. Trial duration was six weeks; patients had acute bipolar depression without psychotic features as determined by the Mini-International Neuropsychiatric Interview and were treated as outpatients. The primary efficacy measure was reduction in total MADRS score at baseline and key secondary assessment was with the CGI-BP depression severity sub-score. In these trials, lurasidone (flexibly dosed from 20–120 mg/d) was superior to placebo on both parameters, showed a good safety profile and was not associated with significant extrapyramidal or metabolic side effects.32,33 While there is a need for corroborating independent studies, lurasidone does emerge as an important medication for the treatment of acute bipolar depression.
Current and emerging pharmacotherapeutic strategies for Tourette syndrome
Published in Expert Opinion on Pharmacotherapy, 2022
Lurasidone is a dopamine and serotonin receptor antagonist used for the treatment of schizophrenia and bipolar affective disorder. In a recently published small case series, this medication was added on to either risperidone or aripiprazole for the treatment of refractory TS with co-morbid obsessive symptoms and aggressive behavior, with encouraging results in terms of control of behavioral symptoms and tolerability (both motor and metabolic adverse effects) [70]. Ecopipam is a first-in-class medication characterized by selective D1 receptor antagonism demonstrated significant tic reduction and good tolerability in both an open-label study [71] and a follow-up randomized, placebo-controlled crossover study of young patients with TS [72]. A phase IIb trial of ecopipam in young patients with TS (D1AMOND study) includes an ongoing open-label extension following the randomization period. The results of the randomized controlled trial component of the D1AMOND study were recently made available: these encouraging findings suggested a 30% reduction in tic severity [73].
Evaluating lurasidone as a treatment option for bipolar disorder
Published in Expert Opinion on Pharmacotherapy, 2020
Ziad Ali, Cunyet Tegin, Rif S. El-Mallakh
Lurasidone is a potent and useful tool for clinicians treating patients with bipolar depression. It is clearly effective in improving depressive symptoms either in monotherapy or as adjunct to common mood stabilizers with an acceptable effect size (0.51 monotherapy, 0.34 adjunct) and NNT (5 and 7 for response, respectively and 6–7 and 7 for remission, respectively) [18]. The effect is seen at 20 mg daily – a dose that provides ≥ 70% receptor occupancy of the 5HT7 receptor (although the average in the low dose range is around 33 mg daily), and there is minimal additional benefit when other receptors are recruited with higher doses, suggesting that 5HT7 blockade is the probable mechanism of action. Additionally, while lurasidone is approved at doses of 100–120 mg daily, such high doses should be used with caution since they will exceed 80% D2 receptor occupancy and may contribute to dysphoria [42]. There is a hint of this in the NNT, which drops from 6 to 7 as the dose range increases [18]. It should be noted that very few subjects in the studies actually reached these doses, precluding any conclusions regarding the use of these high doses (either that these doses work or that they do not).
Asenapine, iloperidone and lurasidone exposures in young children reported to U.S. poison centers
Published in Clinical Toxicology, 2018
Gina Stassinos, Wendy Klein-Schwartz
Lurasidone seems to be the most commonly reported and relatively better studied agent. A state poison center study of 140 lurasidone ingestions was performed from 2011 to 2013 [10]. Twelve cases involved children of 5 years or less, although no subgroup analysis was done. The most common clinical effects were nausea (10.9%), agitation/irritability (12.7%) and drowsiness/lethargy (14.5%). A 2-year retrospective review of 128 single substance lurasidone exposures (25% ages 19 or under) showed mostly none or minor effect and drowsiness/lethargy was most common. However, serious effects such as coma, hypotension and respiratory depression occurred [11]. Lurasidone’s adverse effects were studied in a multicenter ascending dose study. All of the patients in the 120 mg/d dose cohort aged 6-9 years experienced moderate or severe vomiting and sedation or somnolence [12]. Our study supports the previous literature showing that lurasidone may have relatively few major effects, with drowsiness/lethargy and nausea the most common.