Granada Drug Interactions

Effects on lurasidone: Lurasidone is not a substrate of CYP1A1, CYP1A2, CYP2A6, CYP4A11, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6 or CYP2E1 enzymes. This suggests that an interaction of lurasidone with drugs that are inhibitors or inducers of these enzymes is unlikely.
Lurasidone is predominantly metabolized by CYP3A4; interaction of lurasidone with strong and moderate inhibitors or inducers of this enzyme has been observed (Table 5). Lurasidone is contraindicated in combination with strong CYP3A4 inhibitors (e.g. ketoconazole, clarithromycin, ritonavir, voriconazole, mibefradil, etc.) or strong CYP3A4 inducers (e.g., rifampin, avasimibe, St. John's wort, phenytoin, carbamazepine, etc.).
Lithium: It is not necessary to adjust the lurasidone dose when used in combination with lithium (see Table 5).

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Effects on coadministered drug: Digoxin (P-gp substrate): Coadministration of lurasidone (120 mg/day) at steady state with a single dose of digoxin (0.25 mg) increased C_max and AUC_(0-24) for digoxin by approximately 9% and 13%, respectively relative to digoxin alone. Digoxin dose adjustment is not required when coadministered with Lurasidone.
Lithium: Coadministration of lurasidone (120 mg/day) and lithium (1200 mg/day) at steady state resulted in comparable mean lithium C_max values on Day 4 (0.65 mmol/L) and Day 8 (0.75 mmol/L) and maintenance of the therapeutic range for lithium (0.6 to 1.2 mmol/L). No adjustment of lithium dose is required when coadministered with lurasidone.
Midazolam (CYP3A4 substrate): Coadministration of lurasidone (120 mg/day) at steady state with a single dose of 5 mg midazolam increased midazolam C_max and AUC_(0-24) by approximately 21% and 44%, respectively relative to midazolam alone. Midazolam dose adjustment is not required when coadministered with lurasidone.
Oral contraceptive (estrogen/progesterone): Coadministration of lurasidone (40 mg/day) at steady state with an oral contraceptive (OC) containing ethinyl estradiol and norgestimate resulted in equivalent AUC(_0-24) and C_max of ethinyl estradiol and norelgestromin relative to OC administration alone. Also, sex hormone binding globulin levels were not meaningfully affected by coadministration of lurasidone and OC. Dose adjustment of OC dose is not required when coadministered with lurasidone.