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| LETTER TO EDITOR |
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| Year : 2017 | Volume
: 22
| Issue : 1 | Page : 74-75 |
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Lurasidone: Watch out for dystonia
BS Chavan, Ajeet Sidana, Priti Arun, Jasmin Garg
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| Date of Web Publication | 14-Jul-2017 |
Correspondence Address:
Jasmin Garg
Department of Psychiatry, Government Medical College and Hospital, Sector 32, Chandigarh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmhhb.jmhhb_7_17
How to cite this article:
Chavan B S, Sidana A, Arun P, Garg J. Lurasidone: Watch out for dystonia. J Mental Health Hum Behav 2017;22:74-5 |
Sir,
Schizophrenia is a chronic debilitating mental illness which has profound impact on psychosocial functioning of an individual. Even with a wide range of available antipsychotics, achieving complete remission is a daunting task. It signifies the need of newer and better antipsychotics which can decrease the immense burden associated with schizophrenia.
Lurasidone is a novel antipsychotic which has antagonistic effects on D2, 5HT2A, 5HT7, and partial agonistic effect on 5HT1A. It is recently approved in India for the management of schizophrenia and currently widely promoted as being an effective antipsychotic with additional antidepressant properties. It is also claimed to have procognitive properties according to animal studies. Randomized placebo control trials have demonstrated it to be an efficacious antipsychotic. However, there are fewer studies which have compared its effect with other available antipsychotics. Hence, it is not known clearly if it is better than already available antipsychotics in efficacy and tolerability.[1]
Our tertiary care center was part of a multisite Phase III unblinded randomized trial for comparing efficacy and tolerability of lurasidone with quetiapine. The Ethics Committee registration number was ECR/11/Inst/PB/2013. According to the study protocol, patients were randomly assigned to receive fixed dose of either 40 mg or 80 mg of lurasidone per day for 6 weeks on outpatient department basis. We administered lurasidone in drug naîve patients with schizophrenia as a part of this trial, and we are reporting a case who developed a severe adverse effect in the form of generalized dystonia with this novel antipsychotic.
This patient was 21-year-old male with schizophrenia who was drug naive and had no other significant psychiatric or medical history. Informed consent was obtained for inclusion in the trial in June 2015 after ethical clearance. At the time of inclusion, his weight was 58 kg and height 155 cm. His routine biochemistry and hematological tests were normal. On intake, his Positive and Negative Syndrome Scale [2] score was 136 and Clinical Global Impression – Severity [3] score was 6. This patient was administered a single dose of 80 mg of lurasidone orally alone, and within 1 day he was brought by family members in a state of generalized dystonia. He was conscious and appeared significantly distressed and anxious. He had stiffness of body both sides, dysarthria, dysphagia, and abnormal posturing of body with resulting inability to sit or stand independently. His vitals were normal. He was administered an injection of promethazine 50 mg slow intravenously. With this, he recovered completely within few minutes. Due to significant distress caused by this adverse event, the patient was removed from this trial, and he was administered Olanzapine 5mg/day which has a lesser propensity for extrapyramidal adverse events.
Acute dystonia consists of contraction of one or more group of muscles for prolonged periods of time resulting in abnormal uncomfortable postures or repetitive movements. Most commonly, it involves muscles of head and neck group, followed by back, upper, and lower limbs. Infrequently it may also involve whole body, i.e., generalized dystonia. It occurs within hours of administration of an antipsychotic and is very distressing and even painful to the patient. The risk of occurrence is more in males, younger age, or when high-dose potent D2 blockers are initiated. It also occurs when the coadministered anticholinergic agent is suddenly stopped.[4],[5]
With lurasidone, studies have variably reported the frequency of occurrence of extrapyramidal adverse events. Overall, it is reported that lurasidone has lesser chance to cause extrapyramidal adverse events than other potent D2 blocking atypical antipsychotics. Among extrapyramidal adverse events, the majority have reported its propensity to cause akathisia rather than dystonia. Akathisia is reported in approximately 15% of patients. About dystonia, some have reported none, while others have reported an incidence of up to 6%. Data are still emerging about efficacy and tolerability profile of this drug worldwide.[1],[6]
In conclusion, this report demonstrates generalized dystonia as the adverse effect of lurasidone and recommends caution with its prescription in patients with schizophrenia. Either it should be administered in low doses alone or along with anticholinergic agents to prevent the occurrence of this distressing adverse event which frequently leads to noncompliance and dropout. Further studies are required to determine the tolerability and the extent or spectrum of improvement produced by lurasidone in managing schizophrenia.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Sacchetti E, Vita A. Oral lurasidone for people with schizophrenia: Clinical practice recommendations emerging from a review of the literature. Evid Based Psychiatr Care 2016;2:32-52.  |
| 2. | Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261-76. [ PUBMED] |
| 3. | Guy W. ECDEU Assessment Manual for Psychopharmacology: Revised. Bethesda, MD: United States Department of Health, Education, and Welfare; 1976. |
| 4. | van Harten PN, Hoek HW, Kahn RS. Acute dystonia induced by drug treatment. BMJ 1999;319:623-6. [ PUBMED] |
| 5. | Svetel M, Ivanovic N, Marinkovic J, Jovic J, Dragasevic N, Kostic VS. Characteristics of dystonic movements in primary and symptomatic dystonias. J Neurol Neurosurg Psychiatry 2004;75:329-30. |
| 6. | Caccia S, Pasina L, Nobili A. Critical appraisal of lurasidone in the management of schizophrenia. Neuropsychiatr Dis Treat 2012;8:155-68. [ PUBMED] |
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