Category: Fellows Posters
Lurasidone is a second-generation antipsychotic indicated for the treatment of bipolar depression and schizophrenia. It was added to our hospital formulary to allow patients to continue their therapy from home. However, if lurasidone is initiated during hospitalization, the patient must be in the psychiatric unit. The purpose of this study was to assess prescribing practices and adverse events of lurasidone when used at an urban teaching hospital.
This study was approved by the Institutional Review Board. A retrospective chart review was conducted on consecutive patients who were prescribed lurasidone during study period October 2018 through August 2019. A data collection sheet was designed to abstract information on patient demographics, comorbidities, serum creatinine (SCr), Child-Pugh score, hemoglobin A1c (HgA1c), total cholesterol, and white blood cell count (WBC). Information on concomitant medications which strongly induce or inhibit the CYP450 3A4 enzyme, as well as moderate inhibitors of the CYP450-3A4 enzyme, was also collected. Details regarding whether lurasidone was continued from home or initiated during hospital stay was documented. Dosing information, including dose prescribed, dose administered, administration time, and any dose adjustments, was also abstracted. Adverse events were tracked, including tardive dyskinesia, metabolic changes, leukopenia, neutropenia, or agranulocytosis, parkinsonian-like syndrome, and cognitive or motor impairment. Two pharmacists (one clinical pharmacist and one Medication Safety fellow) reviewed the abstracted data for quality control.
Fifty patients were reviewed, and 49 met the inclusion criteria. The average age was 38.8 years (range 19-73), and most were women (79.6%). The most common indication was bipolar depression (49%) followed by major depressive disorder with mixed features (16%). All patients were on lurasidone prior to admission. Forty patients had weight and SCr documented allowing CrCl to be assessed (average 121.4 mL/minute, range 41-212.4). One patient had a CrCl of 41 mL/minute and received lurasidone 80 mg daily, which is consistent with renal dosing recommendations. The Child-Pugh score could not be assessed due to lack of information. Forty patients had WBC reported (average 9.3, range 3.8-22), 4 had HgA1c reported (average 9.25, range 5.0-11.3), and 10 had cholesterol reported (average 106.8, range 100-141). None of the patients received concomitant medications that are strong CYP450 3A4 enzyme inducers or inhibitors; however, one patient received diltiazem with 40 mg of lurasidone, which is appropriate in patients on moderate CYP450 3A4 inhibitors. Thirteen patients were on at least one opioid, and 3 patients were on metoclopramide, which have significant interactions with lurasidone. Of note, 12 patients were admitted for suicidal ideation for which lurasidone has a warning. Adverse events were not reported.
Our review showed that lurasidone was appropriately continued from home according to dose and frequency. The majority of home doses were consistent with manufacturer recommendations for maximum daily dosing and dose adjustments based on renal function. Although none of the patients who received lurasidone during hospital stay developed adverse events during hospitalization, 12 patients receiving lurasidone at home were admitted for suicidal ideation. Suicidal ideation is a black box warning for lurasidone.