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Home , Lurasidone

Medications

First generation block type (D2) receptors in the limbic system, while second generation antipsychotics have a variable profile of receptor activity. Second generation antipsychotics overall have a lower incidence of and other movement disorders, however, their use is associated with higher risk of metabolic side effects.

DRUG CATEGORY MEDICATIONS COMMON SIDE EFFECTS MONITORING PARAMETERS ADDITIONAL COMMENTS First Generation . .Extrapyramidal symptoms (EPS) .Mental status/vital signs Black Box Warnings: (Typical) (IR, Inj)* .Drowsiness, dizziness .Abnormal involuntary .Increased mortality in elderly patients . Antipsychotics . Hyperprolactinemia (can cause movements or Parkinsonian with related sexual side effects, signs (IR, Liq, Inj, Depot) . can cause bronchospasm that gynecomastia) .CBC has the potential to lead to respiratory . . effects (greatest .Ophthalmologic exam if distress and respiratory arrest (IR, Liq, Inj, Depot) with chlorpromazine, prolonged use . .Loxapine (IR, Inh) ) Thioridazine has been shown to prolong .Hypotension Additional Monitoring That May the QT interval in a dose-related . (IR) Be Indicated: manner

. (IR) .Weight, height, body mass index (BMI), and waist Additional: . (IR) circumference .Use chlorpromazine, fluphenazine, .Fasting plasma glucose perphenazine, and pimozide with . caution in patients with renal (IR, Inj, supp) level/HbA1c . panel impairment . Thioridazine (IR) .Electrolytes .Use chlorpromazine, pimozide, .Thiothixene (IR) .LFTs prochlorperazine, and thioridazine with .Serum prolactin caution in patients with hepatic . (IR) .ECG impairment

.Use of fluphenazine, perphenazine, and trifluoperazine is contraindicated in patients with hepatic disease Second . .Weight gain, .Mental status/vital signs Black Box Warnings: Generations (IR, Liq, ODT, hypertriglyceridemia, .Abnormal involuntary .Increased mortality in elderly patients (Atypical) Depot) and risk of insulin resistance and movements or Parkinsonian with dementia-related psychosis Antipsychotics type 2 diabetes (greatest with signs . .Aripiprazole (excluding ER injection), & , lowest .Personal and family history (SL, Patch) , lurasidone, : with ) of obesity, diabetes, increased risk of suicidal ideation in dyslipidemia, hypertension, .Brexpiprazole (IR) .Altered cardiac conduction and children and adolescents or cardiovascular disease prolonged QT interval (greatest . (IR) .Weight, height, body mass .Clozapine: severe neutropenia, seizures, with ziprasidone) index (BMI), waist myocarditis, cardiomyopathy, and mitral .Clozapine .Extrapyramidal symptoms (EPS): circumference valve incompetence, orthostatic (IR, ODT, Liq) much lower extent than the 1st .Blood pressure hypotension, bradycardia, syncope

generation agents, . . (IR) Fasting plasma glucose .Olanzapine ER injection: Post-injection carries the highest risk, clozapine level/HbA1c delirium/sedation syndrome .Lurasidone (IR) carries the lowest risk .Lipid panel

.ANC (clozapine) Additional: .Olanzapine .Hyperprolactinemia (highest in .Use clozapine, lurasidone, olanzapine, (IR, ODT, Inj, Depot) risperidone) Additional Monitoring That May , quetiapine, risperidone, .Anticholinergic effects .Paliperidone Be Indicated: and ziprasidone with caution in patients (clozapine, (ER, Depot) .CBC with renal impairment

olanzapine, quetiapine, .LFTs .Use clozapine, lurasidone, olanzapine, . (IR) risperidone) .Renal function quetiapine, risperidone, and ziprasidone .Serum prolactin .Quetiapine (IR, ER) .Hypothyroidism (quetiapine) with caution in patients with hepatic .Electrolytes impairment . .Neurologic function .Risperidone Drowsiness, dizziness .Thyroid function tests .Clozapine and olanzapine ER injection (IR, Liq, ODT, Inj, .Headache Depot) .ECG must be prescribed in conjunction with .Insomnia .Clozapine, olanzapine levels may the corresponding REMS program .Ziprasidone be lower in patients who smoke .Clozapine: neutropenia, DVT/PE, .Upon discontinuing antipsychotic (IR, Inj) hepatotoxicity, sialorrhea, and therapy, gradual tapering is glaucoma recommended

*Dosage forms available: IR = Immediate Release Oral Formulation, ER= Extended Release Oral Formulation, Liq= Oral Liquid, Inj= Injectable, Depot= Long-acting Injectable, Inh= Inhalation, Supp= Rectal Suppository, SL= Sublingual Tablet, Patch= Patch, ODT= Orally Disintegrating Tablet

Facts and Comparisons [database online]. St. Louis, MO: Wolters Kluwer Health, Inc; 2017. Accessed May 8, 2019 Clinical Pharmacology powered by ClinicalKey. Tampa (FL): Elsevier. c2018▪ [cited 2019 May 8]. Available from: http://www.clinicalkey.com MAPR-FY64684-1019 Revised 1/2/2020