The efficacy and safety of lurasidone in adolescents with bipolar disorder: a up-to-date drug profile

INTRODUCTION: Bipolar disorder (BD) is a psychiatric condition characterized by recurrent episodes of mania or hypomania and depression, impairing psychosocial functioning across-the-lifespan. Pharmacotherapy in youths current includes mood-stabilizers (lithium) and several second/third‑generation antipsychotics (SGAs). Lurasidone (LUR) is a therapeutic, approved by FDA, for the treatment of bipolar depression in youths aged 10 years and older. AREAS COVERED: The authors review the current evidence from published literature on the main pharmacological features of LUR in adolescents with BD. The authors review the efficacy and short- and long-term safety in bipolar adolescents is critically reviewed. Information is also provided on dosing, combinations, the management of side-effects (nausea, akathisia, sedation), along with details on switching to other alternative SGAs and its possible discontinuation after enduring improvement. EXPERT OPINION: Although LUR and olanzapine-fluoxetine combination are the only FDA-approved medications for pediatric bipolar depression, LUR shows promise as a first-line treatment, due to its lower risk of weight gain and metabolic disturbances, and possible effectiveness on neurocognitive dysfunctions of early-onset BD. However, considering our understanding of its efficacy is based on a single RCT, further investigation is warranted. In terms of its long-term safety, currently available safety data suggest that LUR is a good option also for maintenance treatments. However, given that tolerability can change over time, close monitoring is also recommended.