Lurasidone in schizophrenia: new information about dosage and place in therapy

Lurasidone is a newer "atypical" or "secondgeneration" antipsychotic that has received regulatory approval in the US and Canada for the treatment of schizophrenia. Recent changes in lurasidone product labeling include an expansion of the recommended dose range from 40-80 mg/day to 40-160 mg/day, administered once-daily with food. The recommended starting dose is 40 mg/day. Initial dose titration is not required. Efficacy for the treatment of acute episodes of schizophrenia was established in five, 6-week, fixed-dose, randomized, placebo-controlled trials. Additional short-term studies in patients with schizophrenia include a 3-week, randomized, double-blind trial comparing lurasidone with ziprasidone on safety and tolerability outcomes, and a 6-week, randomized, open-label switch study. Available long-term data includes a 12-month, doubleblind safety and tolerability study comparing lurasidone with risperidone; a 6-month, openlabel extension study for one of the shortterm registration studies where patients were initially randomized to receive lurasidone, olanzapine, or placebo; and a 12-month, doubleblind extension study comparing lurasidone with quetiapine extended-release after having received lurasidone, quetiapine extendedrelease, or placebo for 6 weeks. The totality of the evidence supports the overall tolerability of lurasidone, with minimal weight gain and no clinically-meaningful alterations in glucose, lipids, or the electrocardiogram corrected QT (ECG QTc) interval. The most commonly encountered adverse events that can be observed with lurasidone are somnolence, akathisia, nausea, and parkinsonism. Additional clinical trials are underway for the use of lurasidone in patients with bipolar disorder, including major depressive episodes in patients with bipolar I disorder, and in bipolar and schizophrenia maintenance. Principal advantages over some other second-generation antipsychotics are lurasidone's highly favorable metabolic profile and once-daily dosing regimen. Additional studies are desirable to directly compare and contrast lurasidone's efficacy with other antipsychotic agents.