Is Lurasidone an Antipsychotic?
Yes, lurasidone is definitively an atypical (second-generation) antipsychotic medication. 1
FDA-Approved Classification and Indications
Lurasidone hydrochloride is classified by the FDA as an atypical antipsychotic belonging to the benzisothiazol derivative chemical class. 1 The drug received initial U.S. approval in 2010 and is specifically indicated for:
- Bipolar I disorder depressive episodes (bipolar depression) in adults and pediatric patients aged 10-17 years as monotherapy 1
- Bipolar I disorder depressive episodes in adults as adjunctive therapy with lithium or valproate 1
Pharmacological Mechanism
Lurasidone functions as an antipsychotic through multiple receptor mechanisms:
- Strong antagonist activity at dopamine D2 and serotonin 5-HT2A receptors (the hallmark of atypical antipsychotics) 2, 3
- Distinctive 5-HT7 antagonistic activity (highest affinity among second-generation antipsychotics) 2, 4
- Partial agonism at 5-HT1A receptors 2, 3
- Modest antagonism at noradrenergic α2A and α2C receptors 2
- No antihistaminic or anticholinergic activity 2
Clinical Context Within Antipsychotic Class
While lurasidone is classified as an atypical antipsychotic, its current FDA-approved indications focus on bipolar depression rather than schizophrenia (though it is approved for schizophrenia in other countries including Canada, the EU, Switzerland, and Australia). 5, 2, 6 This distinguishes it from many other atypical antipsychotics that are primarily indicated for schizophrenia or acute psychosis in the United States. 7
The medication shares the typical atypical antipsychotic characteristic of lower extrapyramidal side effects compared to traditional antipsychotics, though akathisia and parkinsonism remain notable adverse effects. 1, 3, 4
Important Clinical Considerations
Dosing requirements: Lurasidone must be administered with food (at least 350 calories) as this substantially increases absorption. 1 The recommended dose range is 20-120 mg/day for bipolar depression. 1
Metabolic profile advantage: Unlike many atypical antipsychotics, lurasidone demonstrates minimal effects on weight gain, lipid profiles, and glycemic control. 5, 6, 3
Drug interactions: Lurasidone is contraindicated with strong CYP3A4 inhibitors (e.g., ketoconazole) and strong CYP3A4 inducers (e.g., rifampin). 1