Food Matters: Reduction of Lurasidone-Induced Nausea With Meals

Food Matters:

Reduction of Lurasidone-Induced Nausea With Meals

Venkata Kolli, MBBSa; Anureet Walia, MBBSb; and Shannon Kinnan, MDa

Lurasidone is a second-generation antipsychotic agent approved by the US Food and Drug Administration for the treatment of schizophrenia and bipolar disorder. Approximately 12%-16% of patients taking lurasidone experience nausea.1 We report a case of a reduction of lurasidone-induced nausea with its ingestion with meals. Mitigation of side effects can improve medication adherence and clinical outcomes.

Case report. A 31-year-old woman taking lamotrigine was augmented with lurasidone 60 mg for bipolar disorder. She reported an improvement of her bipolar symptoms with the addition of lurasidone. Her bipolar symptoms included irritability, increased energy, reduced need for sleep, and increased risk-taking and sexual promiscuity. However, she reported experiencing nausea throughout the day for the first 2 months of taking lurasidone 60 mg. She would occasionally experience retching and episodes of vomiting during the day despite taking lurasidone at bedtime. The patient requested to switch her antipsychotic given these troublesome side effects. On further exploration, the physician discovered that the patient had previously experienced this side effect when taking lurasidone in a fasting state. She was instructed to take lurasidone with her evening meals, and her daytime nausea completely disappeared. Six months later, she developed a rash, and lamotrigine was stopped. Her lurasidone dose was increased to 80 mg, and she experienced no nausea with either the fasting or fed state. Unfortunately, she developed sexual side effects, and to mitigate these side effects, the dose was lowered to 60 mg and later to 40 mg. On the 60-mg dose, she again could not tolerate the medication due to nausea if taken in the fasting state but could if taken with food. Nausea did not recur when the dose was further reduced to 40 mg with food administration.

Our literature search in Embase and MEDLINE databases revealed no previous case reports of reduction of nausea with meal ingestion. It is interesting that the rates of nausea are lowest at the 160-mg dose of lurasidone, relative to lower doses of 120 mg and 80 mg, suggesting a dose-related alleviation of nausea.2 Lurasidone has dopaminergic D2 receptor antagonism and a serotonergic 5-HT1A partial agonism.3 5-HT1A agonism and dopaminergic antagonism can reduce nausea.4 There is also genetic polymorphism of 5-HT1A expression, and lurasidone with its partial agonism can lower the activity of 5-HT1A receptors. Absorption of lurasidone is impacted by food—ingesting lurasidone in a fasting state can reduce its bioavailability by almost 50% relative to when taken with meals.5 We hypothesize that at lower serum lurasidone levels, the partial agonism lowering of 5-HT1A activity resulted in nausea, which was unchecked due to low dopamine antagonism. Higher serum lurasidone levels result in higher dose-dependent dopamine antagonism, and this counters the nausea due to low 5-HT1A activity, which could explain the dose-dependent alleviation of nausea with lurasidone.

Side effects impact medication adherence and future clinical outcomes. Therefore, we suggest that clinicians emphasize lurasidone ingestion with food, not only for maximum bioavailability but also for tolerability.

Potential conflicts of interest: None.

Funding/support: None.

Patient consent: Consent was received from the patient to publish this case report, and information has been de-identified to protect anonymity.

Published online: March 7, 2019.

REFERENCES

1. Citrome L. Lurasidone in schizophrenia: new information about dosage and place in therapy. Adv Ther. 2012;29(10):815-825. PubMed CrossRef

2. Citrome L. Lurasidone for the acute treatment of adults with schizophrenia: what is the number needed to treat, number needed to harm, and likelihood to be helped or harmed? Clin Schizophr Relat Psychoses. 2012;6(2):76-85. PubMed CrossRef

3. Riva MA. An update of the preclinical profile of lurasidone. Evidence-Based Psychiatric Care. 2015;1:67-72.

4. Kenward H, Pelligand L, Savary-Bataille K, et al. Nausea: current knowledge of mechanisms, measurement and clinical impact. Vet J. 2015;203(1):36-43. PubMed CrossRef

5. Citrome L. Lurasidone for schizophrenia: a review of the efficacy and safety profile for this newly approved second-generation antipsychotic. Int J Clin Pract. 2011;65(2):189-210. PubMed CrossRef

aDepartment of Psychiatry, Creighton University, Omaha, Nebraska

bCreighton Psychiatry Residency Program, Omaha, Nebraska

*Corresponding author: Venkata Kolli, MBBS, Department of Psychiatry, Creighton University, 3528 Dodge Street, Omaha, Nebraska, 68131 (kollivb@gmail.com).

Prim Care Companion CNS Disord 2019;21(2):18l02343

To cite: Kolli V, Walia A, Kinnan S. Food matters: reduction of lurasidone-induced nausea with meals. Prim Care Companion CNS Disord. 2019;21(2):18l02343.

To share: https://doi.org/10.4088/PCC.18l02343

© Copyright 2019 Physicians Postgraduate Press, Inc.