ABSTRACT
El manejo farmacológico del episodio depresivo en contexto del trastorno bipolar constituye un desafío para el clínico tanto en psiquiatría adultos como infantoadolescente. El presente trabajo tiene por objetivo actualizar y sintetizar la evidencia disponible respecto al manejo farmacológico para la depresión bipolar en población pediátrica. Metodología: Se realizó una búsqueda de las publicaciones de los últimos 5 años en bases de datos. Resultados: La evidencia muestra como primera línea el uso de antipsicóticos de segunda generación por sobre los estabilizadores del ánimo en este grupo etario; demostrando lurasidona y lanzapina/fluoxetina eficacia similares. Lurasidona es una opción con mejor perfil de seguridad por asociarse a menos efectos adversos y mejor adherencia. El uso de antidepresivos debe considerarse dentro de los pasos iniciales del manejo, asociado a un antipsicótico de segunda generación. Conclusiones: Se destaca la importancia de la sospecha, evaluación y diagnóstico adecuado para guiar la decisión de manejo integral. A pesar de los riesgos y consideraciones existentes, es importante considerar el uso en primera línea de antipsicóticos de segunda generación y de antidepresivos en el manejo de un cuadro depresivo en contexto de la enfermedad bipolar. La escasez de estudios en el tratamiento farmacológico de la depresión bipolar en general y especialmente en población pediátrica limita la generalización y extrapolación de los resultados a la realidad local.
The pharmacological management of the depressive episode in the context of bipolar disorder constitutes a challenge for the clinician both in adult and child-adolescent population. The objective of this paper is to update and synthesize the available evidence regarding the pharmacological management of bipolar depression in the pediatric population. Methodology: A search of the publications of the last 5 years in databases was carried out. Results: The evidence shows the use of second generation antipsychotics over mood stabilizers as the first line in this age group; demonstrating similar efficacy. Results: The evidence shows the use of second generation antipsychotics over mood stabilizers as the first line in this age group; demonstrating similar efficacy lurasidone and lanzapine/fluoxetine. Lurasidone is an option with a better safety profile as it is associated with fewer adverse effects and better adherence. The use of antidepressants should be considered within the initial steps of management, associated with a second generation antipsychotic. Conclusions: The importance of suspicion, evaluation and adequate diagnosis to guide the decision of comprehensive management is highlighted. Despite the existing risks and considerations, it is important to consider the first-line use of second-generation antipsychotics and antidepressants in the management of a depressive episode in the context of bipolar illness. The scarcity of studies on the pharmacological treatment of bipolar depression in general and especially in the pediatric population limits the generalization and extrapolation of the results to the local reality.
Subject(s)
Humans , Child , Adolescent , Bipolar Disorder/drug therapy , Antidepressive Agents, Second-Generation/therapeutic use , Depression/drug therapy , Antipsychotic Agents/therapeutic use , Lurasidone Hydrochloride/therapeutic use , Olanzapine/therapeutic useABSTRACT
Introduction: Schizophrenia is a debilitating disorder, whichhas affected the lives of the diseased & the people aroundthem in troublesome. New interventions are made regularly forthe best outcomes from the available treatments. Aim of thestudy of to compare the efficacy & side-effect profile of the newdrug-Lurasidone with other atypical anti-psychoticsolanzapine, risperidone & quitiapine.Materials & Methods: The presented study was conductedover the duration of 15 months (January 2018- March 2019).This study comprises of 100 subjects, who were divided in 4groups & drugs were randomly provided to them (25 each).Subjects were evaluated using various instruments.Results: It was found that the efficacy of Lurasidone wasalmost similar to other drugs, although scoring better withPANSS & BPRS. Metabolic changes i.e., serum cholesterol,serum LDL, HDL, VLDL levels were found greater in otherdrugs as compared to lurasidone. Fasting glucose levels andweight gain were found to be increased in drugs especiallyolanzapine when compared with lurasidone.
ABSTRACT
OBJECTIVE: Lurasidone is an antipsychotic drug that shows a relative lack of weight gain common to many antipsychotics. Aripiprazole and ziprasidone also show little weight gain and can reduce olanzapine-induced food intake and weight gain in animals, paralleling some clinical findings. We hypothesized that lurasidone would have similar actions. METHODS: Female Lister-hooded rats received intraperitoneal injection either 2× vehicle (saline), lurasidone (3 mg/kg) and vehicle, olanzapine (1 mg/kg) and vehicle, or olanzapine and lurasidone. Following drug administration food intake was measured for 60min. A further series of rats underwent a seven-day regime of once-daily administration of the above doses and free access to food and water. Weight gain over the course of the study was monitored. RESULTS: Olanzapine induced a significant increase in food intake while lurasidone showed no significant effect. Co-administration of lurasidone with olanzapine suppressed the increase in food intake. Repeated dosing showed an increase in body weight after seven days with olanzapine, and no significant effect observed with lurasidone, while repeated administration of lurasidone with olanzapine reduced the effect of olanzapine on the increase in body weight. CONCLUSION: These findings support our hypotheses in that lurasidone, in addition to a lack of effect on acute food intake and short term weight gain, can reduce olanzapine-induced food intake and weight gain in rats. This indicates the drug to have an active anti-hyperphagic mechanism, rather than solely the absence of a drug-induced weight gain that is such a severe limitation of drugs such as olanzapine.
Subject(s)
Animals , Female , Humans , Rats , Antipsychotic Agents , Aripiprazole , Body Weight , Eating , Injections, Intraperitoneal , Lurasidone Hydrochloride , Water , Weight GainABSTRACT
OBJECTIVE:To prepare the lurasidone hydrochloride solid dispersion,and improve its dissolution rate. METH-ODS:Taking povidone K30 as the carrier,solvent method was used to prepare the lurasidone hydrochloride solid dispersion with different drug-load ratios(1:0.5,1:1,1:2). The in vitro dissolution rates of 3 kinds of lurasidone hydrochloride solid dispersion with physical mixture (lurasidone hydrochloride-povidone K30) and original preparation were compared. X-ray powder diffraction method was adopted to analyze the crystal structures of raw material of lurasidone hydrochloride,povidone K30 and accessories, physical mixture (1:2) and accessories,and lurasidone hydrochloride solid dispersion (1:2) and accessories. RESULTS:Com-pared with physical mixture,the dissolution rate of lurasidone hydrochloride solid dispersion with drug-load ratios of 1:0.5,1:1, 1:2 was significantly improved,and the dissolution rate of solid dispersion was increased as the increase of the carrier ratio. The in vitro dissolution rates of lurasidone hydrochloride solid dispersion with drug-load ratio of 1:2 and original preparation were respec-tively 101.2%and 100.2%in 20 min. X-ray powder diffraction showed,there were characteristic absorption peaks of lurasidone hy-drochloride and accessories in physical mixture;the characteristic absorption peak of lurasidone hydrochloride in solid dispersion disappeared basically,and the characteristic absorption peak of accessories still existed. CONCLUSIONS:The in vitro dissolution of lurasidone hydrochloride solid dispersion with drug-load ratio of 1:2 is similar to original preparation,and lurasidone hydrochlo-ride exists in the solid dispersion as amorphous form.
ABSTRACT
Lurasidone is a new atypical antipsychotic drug, it was approved by the Food and Drug Administration ( FDA ) for treatment of schizophrenia on october 28,2010.The article is to provide an review about pharmacological effects, clinical applications, pharmacokinetics, dosage, drug interactions, adverse reactions of Lurasidone.
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Objective:To determine the content of self-manufactured and imported lurasidone hydrochloride tablets in order to e-valuate their internal qualities. Methods:The determination of lurasidone hydrochloride tablets was performed by HPLC. The HPLC system consisted of a Waters C8 column (250 mm × 4. 6 mm, 3. 5 μm) and the mobile phase of 0. 05 mol·L-1 phosphate buffer solu-tion (pH 3. 0)-acetonitrile(60∶40), the detection wavelength was 230 nm, the flow rate was 1. 2 ml·min-1 and the column tempera-ture was 40℃, and the injection volume was 20μl. Results:The linear range of lurasidone hydrochloride was 0. 100 8-0. 806 4 mg· ml-1(r=0. 999 5). The average recovery was 99. 95% with RSD of 0. 31%(n=9). Conclusion:The method is simple, rapid, ac-curate, and reliable. The method can determine lurasidone hydrochloride tablets satisfactorily. According to the results, there are few differences among the self-manufactured and imported lurasidone hydrochloride tablets.
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Objective:To establish the determination method for four lurasidone hydrochloride enantiomers by HPLC. Methods:Lurasidone hydrochloride enantiomers were separated on a CHIRALPAK AD-H column (250 mm × 4. 6 mm, 5μm). The mobile phase consisted of hexane-ethanol-diethylamine ( 90∶10∶0. 1) at a flow rate of 1. 0 ml·min-1 and the column temperature was at 40℃. The detection wavelength was 230nm. Results:The resolution of lurasidone hydrochloride enantiomers was above 2. 0. The linear calibra-tion curves were obtained over the range of 5-120 μg· ml-1 for all the enantiomers (r=0. 999 9). The recovery was above 99. 0%with RSD below 0. 5%. The detection limits were 5ng. Conclusion:The method is simple, accurate and rapid, and suitable for the de-termination and quality control.