lumateperone

General

Pronunciation:
loo-ma-te-per-one

Trade Name(s)

  • Caplyta

Ther. Class.
antipsychotics

Pharm. Class.
serotonin-dopamine activity modulators (SDAM)

Indications

Schizophrenia.

Action

Psychotropic activity may be due to antagonist activity at the central serotonin 5-HT2A  receptors and central dopamine D2  receptors.

Therapeutic Effect(s):

Decreased manifestations of schizophrenia.

Pharmacokinetics

Absorption: Poorly absorbed (4%) following oral administration.

Distribution: Widely distributed to extravascular tissues.

Protein Binding: 97%.

Metabolism and Excretion: Extensively metabolized in the liver via various enzymes, including UDP-glucuronosyltransferase (UGT), aldoketoreductases, as well as CYP1A2, CYP2C8, and CYP3A4. Excreted in urine (58%) and feces (29%), primarily as metabolites.

Half-life: 18 hr.

TIME/ACTION PROFILE (plasma concentrations)

ROUTEONSETPEAKDURATION
POunknown1–2 hr24 hr

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity
  • Moderate or severe hepatic impairment
  • Concurrent use of strong or moderate CYP3A4 inhibitors or UGT inhibitors
  • Concurrent use with CYP3A4 inducers
  • Lactation: Lactation.

Use Cautiously in:

  • Dehydration, use of antihypertensives, cardiovascular disease, or cerebrovascular disease (↑ risk of orthostatic hypotension and/or syncope);
  • Low white blood cell count or absolute neutrophil count or history of drug-induced leukopenia or neutropenia (↑ risk of leukopenia and/or neutropenia)
  • Patients at risk for aspiration or falls;
  • Seizure disorders;
  • OB:  Neonates at ↑ risk for extrapyramidal symptoms and withdrawal after delivery when exposed during the 3rd trimester; use during pregnancy only if potential maternal benefit outweighs potential fetal risk;
  • Pedi:   Safety and effectiveness not established in children;
  • Geri:  ↑ risk of mortality in older adults treated for psychosis related to dementia.

Adverse Reactions/Side Effects

CV: orthostatic hypotension, syncope, tardive dyskinesia

Endo: hyperglycemia

GI: dry mouth, dysphagia, ↑ liver enzymes, nausea, vomiting

GU: ↓ fertility

Hemat: leukopenia, neutropenia

Metabolic: ↓ appetite, dyslipidemia, ↑ weight

MS: dystonic reactions, ↑ creatine kinase

Neuro: SEIZURES, drowsiness, dizziness, extrapyramidal reactions, hyperthermia

Misc: NEUROLEPTIC MALIGNANT SYNDROME, falls, fatigue, hypersensitivity reactions (including rash, pruritus, and urticaria)

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

Drug-Natural Products:

 St. John's wort  may ↓ levels and effectiveness; avoid concurrent use.

Drug-Food:

Grapefruit juice may ↑ levels and risk of toxicity; avoid concurrent use.

Route/Dosage

PO (Adults): 42 mg once daily.

Availability

Capsules: 42 mg

Assessment

  • Monitor patient's mental status (orientation, mood, behavior) before and periodically during therapy.
  • Assess weight and BMI initially and periodically during therapy. Refer as appropriate for nutritional/weight management and medical management.
  • Observe patient carefully when administering medication to ensure that medication is actually taken and not hoarded or cheeked.
  • Lumateperone lowers the seizure threshold. Institute seizure precautions for patients with history of seizure disorder.
  • Monitor patient for onset of extrapyramidal side effects ( akathisia– restlessness dystonia– muscle spasms and twisting motions; or  pseudoparkinsonism– mask-like face, rigidity, tremors, drooling, shuffling gait, dysphagia). Report these symptoms; reduction of dose or discontinuation of medication may be necessary.
  • Monitor for possible tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue). Report these symptoms immediately; may be irreversible.
  • Monitor for development of neuroleptic malignant syndrome (fever, muscle rigidity, altered mental status, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, loss of bladder control). Notify health care professional immediately if these symptoms occur.
  • Assess for falls risk. Drowsiness, orthostatic hypotension, and motor and sensory instability increase risk. Institute prevention if indicated.

Lab Test Considerations:

Monitor patients with clinically significant neutropenia for fever or other symptoms or signs of infection and treat promptly if such symptoms or signs occur. Discontinue lumateperone in patients with absolute neutrophil count <1000/mm3  and follow WBC until recovery.

  • Assess fasting blood glucose and cholesterol levels before starting and periodically during therapy.
  • Monitor liver function tests periodically during therapy or if clinical signs of hepatotoxicity occur.

Potential Diagnoses

Implementation

  • PO Administer once daily with food.

Patient/Family Teaching

  • Instruct patient to take medication as directed.
  • Inform patient of possibility of extrapyramidal symptoms and tardive dyskinesia. Instruct patient to report these symptoms immediately.
  • Instruct patient to avoid grapefruit juice during therapy.
  • Advise patient to change positions slowly to minimize orthostatic hypotension. Protect from falls.
  • Inform patient that lumateperone may cause weight gain. Advise patient to monitor weight periodically. Notify health care professional of significant weight gain.
  • May cause seizures and drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to drug is known.
  • Advise patient to avoid extremes in temperature and dehydration; this drug impairs body temperature regulation.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any other medications, especially St. John's Wort. Caution patient to avoid concurrent use of alcohol and other CNS depressants.
  • Instruct patient to use frequent mouth rinses, good oral hygiene, and sugarless gum or candy to minimize dry mouth.
  • Advise patient to notify health care professional of medication regimen before treatment or surgery.
  • Instruct patient to notify health care professional immediately if signs and symptoms of neuroleptic malignant syndrome occur unexplained fatigue, dyspnea, tachypnea, chest pain, palpitations, sore throat, fever, lethargy, weakness, malaise, or flu-like symptoms occur.
  • Rep:  Advise female patients to notify health care professional if pregnancy is planned or suspected, and to avoid breast feeding. Encourage women who become pregnant while taking lumateperone to enroll in the National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or visit http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregi.... Monitor neonates for extrapyramidal and/or withdrawal symptoms and manage symptoms appropriately. May temporarily cause male and female infertility.

Evaluation/Desired Outcomes

  • Decrease in positive symptoms (delusions, hallucinations) of schizophrenia.
  • Decrease in negative symptoms (social withdrawal, flat, blunted affect) of schizophrenia.
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