Second-generation (atypical) antipsychotic
Antagonist at dopamine D2 and serotonin 5-HT2A receptors; also acts as a 5-HT7 antagonist and partial agonist at 5-HT1A receptors, which may contribute to antidepressant and cognitive effects
Schizophrenia, bipolar depression (as monotherapy or adjunct to lithium/valproate)
Major depressive disorder (MDD) with mixed features, postpartum psychosis, psychotic depression
Oral tablets (20 mg, 40 mg, 60 mg, 80 mg, 120 mg)
20 mg p.o. daily with food (≥350 calories); titrate in 20 mg increments based on response and tolerability
20–160 mg/day
Half-life ~18 hours; metabolized via CYP3A4; steady state in ~7 days
Akathisia, nausea, somnolence, restlessness, extrapyramidal symptoms (EPS), insomnia
Tardive dyskinesia, neuroleptic malignant syndrome (NMS), orthostatic hypotension
Monitor weight, fasting glucose, lipids, and EPS symptoms every 3–6 months; assess for adherence to food requirement for absorption
Increased risk of mortality in elderly patients with dementia-related psychosis; increased risk of suicidality in children, adolescents, and young adults with mood disorders
Lurasidone is often favored in patients with metabolic syndrome, obesity, or diabetes due to its minimal effects on weight, glucose, and lipid parameters. While it is sometimes used off-label in elderly patients with dementia-related psychosis or agitation, it carries the same increased mortality risk as other antipsychotics in this population and should be used with caution. It may be a reasonable choice in younger individuals or those with bipolar depression and cognitive symptoms due to its serotonergic profile. Lurasidone is contraindicated with strong CYP3A4 inhibitors or inducers, and clinicians should monitor for EPS, especially in patients with a history of sensitivity to extrapyramidal side effects.