Mechanism of action and pharmacology

Receptor binding of CAPLYTA:

The antipsychotic activity of CAPLYTA is thought to be mediated through a combination of antagonism of serotonin 5-HT2A receptors and postsynaptic antagonism of dopamine D2 receptors.

The mechanism of action of CAPLYTA is unknown.1

  1. 1

    5-HT2A
    High Affinity1

    Nearly full saturation for serotonin 5-HT2A

    • Allows for lower amounts of D2 receptor occupancy at therapeutic doses2

    D2
    Moderate Affinity1

    39% receptor occupancy3

    • High D2 receptor occupancy is linked to increased risks of EPS and elevated prolactin levels2
  2. 2

    SERT
    Moderate Affinity1

    • Inhibition of SERT contributes to increased serotonin in the synapse2
  3. 3

    D1
    Moderate Affinity1

    • May contribute to indirect activation of the glutamatergic AMPA and NMDA receptors4
  4. 4

    OFF-TARGET RECEPTORS
    Low Affinity

    (e.g., histaminergic and muscarinic receptors)1

A graphic that explains CAPLYTA's mechanism of action (MOA).

EPS=extrapyramidal symptoms.

Receptor-binding profile of CAPLYTA1,2

This graphic demonstrates how CAPLYTA is thought to be mediated through a combination of antagonism of serotonin 5-HT2A receptors and postsynaptic antagonism of dopamine D2 receptors.
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Frequently Asked Questions

What is the generic name of CAPLYTA?

The generic name of CAPLYTA is lumateperone.1

What drug class is CAPLYTA?

CAPLYTA belongs to a class of drugs known as atypical antipsychotics.1

What is the half-life of CAPLYTA and how long does it take to get to steady state?

The clearance of CAPLYTA is about 27.9 L/hour and the terminal half-life of CAPLYTA is about 18 hours after administration.1 Following a once-daily oral administration of CAPLYTA, steady state is reached in about 5 days.1

What is CAPLYTA's effect on the dopamine D1 receptor?

CAPLYTA exhibits moderate affinity for the dopamine D1 receptor.1 The binding of CAPLYTA to the dopamine D1 receptor may contribute to indirect activation of the glutamatergic AMPA and NMDA receptors.4 The clinical relevance of CAPLYTA receptor-binding affinities is unknown.1

CAPLYTA is indicated in adults for the treatment of schizophrenia and depressive episodes associated with bipolar I or II disorder (bipolar depression), as monotherapy and as adjunctive therapy with lithium or valproate.

Important Safety Information

Boxed Warnings:

  • Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. CAPLYTA is not approved for the treatment of patients with dementia-related psychosis.
  • Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adults in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and behaviors. The safety and effectiveness of CAPLYTA have not been established in pediatric patients.

Contraindications: CAPLYTA is contraindicated in patients with known hypersensitivity to lumateperone or any components of CAPLYTA. Reactions have included pruritus, rash (e.g., allergic dermatitis, papular rash, and generalized rash), and urticaria.

Warnings & Precautions: Antipsychotic drugs have been reported to cause:

  • Cerebrovascular Adverse Reactions in Elderly Patients with Dementia-Related Psychosis, including stroke and transient ischemic attack. See Boxed Warning above.
  • Neuroleptic Malignant Syndrome, which is a potentially fatal reaction. Signs and symptoms include hyperpyrexia, muscle rigidity, delirium, autonomic instability, elevated creatinine phosphokinase, myoglobinuria (and/or rhabdomyolysis), and acute renal failure. Manage with immediate discontinuation of CAPLYTA and provide intensive symptomatic treatment and monitoring.
  • Tardive Dyskinesia (TD), a syndrome of potentially irreversible, dyskinetic, and involuntary movements which may increase as the duration of treatment and total cumulative dose increases. The syndrome can develop after a relatively brief treatment period, even at low doses, or after treatment discontinuation. Given these considerations, CAPLYTA should be prescribed in a manner most likely to reduce the risk of TD. Discontinue CAPLYTA if clinically appropriate.
  • Metabolic Changes, including hyperglycemia, diabetes mellitus, dyslipidemia, and weight gain. Hyperglycemia, in some cases extreme and associated with ketoacidosis, hyperosmolar coma or death, has been reported in patients treated with antipsychotics. Measure weight and assess fasting plasma glucose and lipids when initiating CAPLYTA and monitor periodically during long-term treatment.
  • Leukopenia, Neutropenia, and Agranulocytosis (including fatal cases). Perform complete blood counts in patients with pre-existing low white blood cell count (WBC) or history of leukopenia or neutropenia. Discontinue CAPLYTA if clinically significant decline in WBC occurs in absence of other causative factors.
  • Orthostatic Hypotension and Syncope. Monitor heart rate and blood pressure and warn patients with known cardiovascular or cerebrovascular disease. Orthostatic vital signs should be monitored in patients who are vulnerable to hypotension.
  • Falls. CAPLYTA may cause somnolence, postural hypotension, and motor and/or sensory instability, which may lead to falls and, consequently, fractures and other injuries. Assess patients for risk when using CAPLYTA.
  • Seizures. Use CAPLYTA cautiously in patients with a history of seizures or with conditions that lower seizure threshold.
  • Potential for Cognitive and Motor Impairment. Advise patients to use caution when operating machinery or motor vehicles until they know how CAPLYTA affects them.
  • Body Temperature Dysregulation. Use CAPLYTA with caution in patients who may experience conditions that may increase core body temperature such as strenuous exercise, extreme heat, dehydration, or concomitant anticholinergics.
  • Dysphagia. Use CAPLYTA with caution in patients at risk for aspiration.

Drug Interactions: Avoid concomitant use with CYP3A4 inducers. Reduce dose for concomitant use with strong CYP3A4 inhibitors (10.5 mg) or moderate CYP3A4 inhibitors (21 mg).

Special Populations: Neonates exposed to antipsychotic drugs during the third trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery. Reduce dose for patients with moderate or severe hepatic impairment (21 mg).

Adverse Reactions: The most common adverse reactions in clinical trials with CAPLYTA vs placebo were:

  • Schizophrenia: somnolence/sedation (24% vs 10%) and dry mouth (6% vs 2%).
  • Bipolar Depression (Monotherapy, Adjunctive therapy): somnolence/sedation (13% vs 3%, 13% vs 3%), dizziness (8% vs 4%, 11% vs 2%), nausea (8% vs 3%, 9% vs 4%), and dry mouth (5% vs 1%, 5% vs 1%).

CAPLYTA is available in 10.5 mg, 21 mg, and 42 mg capsules.

Indications

CAPLYTA is indicated in adults for the treatment of schizophrenia and depressive episodes associated with bipolar I or II disorder (bipolar depression), as monotherapy and as adjunctive therapy with lithium or valproate.

Please see full Prescribing Information, including Boxed Warnings.

References: 1. CAPLYTA prescribing information. 2. Davis RE, Correll CU. ITI-007 in the treatment of schizophrenia: from novel pharmacology to clinical outcomes. Expert Rev Neurother. 2016(6):601-614. Accessed May 1, 2024. 3. Vanover KE, Davis RE, Zhou Y, et al. Dopamine D2 receptor occupancy of lumateperone (ITI-007): a Positron Emission Tomography Study in patients with schizophrenia. Neuropsychopharmacology. 2019;44(3):598-605. Accessed May 1, 2024. doi:10.1038/s41386-018-0251-1. 4. Kumar B, Kuhad A, Kuhad A. Lumateperone: a new treatment approach for neuropsychiatric disorders. Drugs Today (Barc). 2018;54(12):713-719. Accessed May 1, 2024.

Boxed Warnings:

  • Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. CAPLYTA is not approved for the treatment of patients with dementia-related psychosis.