Canasa
Canasa
Generic Name
Canasa
Mechanism
Canasa is a second‑generation antipsychotic that modulates multiple neurotransmitter systems:
• Dopamine D₂ receptor blockade in the mesolimbic pathway → reduces positive psychotic symptoms.
• Serotonin 5‑HT₂A receptor antagonism → improves negative symptoms and cognitive dysfunction.
• Partial agonism at 5‑HT₁A receptors → contributes to mood stabilization.
• Indirect modulation of NMDA‑glutamate signaling through downstream kinase pathways → lowers excitotoxicity.
This balanced D₂/5‑HT₂A profile yields antipsychotic efficacy with a lower risk of extrapyramidal symptoms.
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Pharmacokinetics
| Parameter | Value |
| Absorption | Rapid oral → Cmax ~4 h |
| Bioavailability | ~55 % (first‑pass hepatic variability) |
| Distribution | 95 % protein‑bound; Vd ≈ 4 L/kg |
| Metabolism | CYP3A4 (70 %), CYP2D6 (20 %) → inactive metabolites |
| Half‑life | 35–45 h (supports once‑daily dosing) |
| Elimination | Predominantly fecal; 2‑fold; CYP2D6 inducers (rifampin) ↓ exposure |
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Indications
- Acute & maintenance schizophrenia (adults & ≥12 yrs adolescents)
- Acute manic or mixed bipolar I episodes
- Adjunctive therapy for major depressive disorder with psychotic features (investigational)
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Dosing
| Population | Starting Dose | Maintenance Range | Max | Titration |
| Adults | 1 mg PO q.d. | 2–4 mg q.d. | 8 mg q.d. | +1 mg every 3–5 days if tolerated |
| Elderly/Renal/Hepatic‑impaired | 0.5 mg q.d. | 0.5–2 mg q.d. | 4 mg q.d. | +0.5 mg every 7 days |
| Children (12–17 yrs) | 0.5 mg q.d. | 1–2 mg q.d. | 4 mg q.d. | Adult titration schedule |
Take with or without food. Avoid alcohol. Store 15–30 °C protected from light.
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Adverse Effects
| Frequency | Adverse Effect |
| ≥10 % | Somnolence, dry mouth, weight gain, mild orthostatic hypotension |
| 1–10 % | Dizziness, constipation, blurred vision, mild sedation, transient metabolic changes |
| ≤1 % | Neuroleptic malignant syndrome, significant QTc prolongation, severe hypotension, rare anaphylaxis |
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Monitoring
- Baseline: CBC, CMP, fasting lipids, fasting glucose/HbA1c, BMI, BP, pulse, ECG (QTc).
- During therapy:
- 4–6 wk: weight, BP, ECG if QTc‑risk factors.
- Every 3 mo: CMP, lipids, glucose.
- Monitor for NMS symptoms after initiation or dose changes.
- Special: Check sodium (SIADH risk) if on diuretics.
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Clinical Pearls
1. Plateau Effect – Maximal antipsychotic benefit may take ≤4 weeks; premature discontinuation is common.
2. CYP3A4 Interaction Hotspot – Concomitant azole antifungals can ↑ trough concentrations 4‑fold; reduce dose by 50 % or use an alternative.
3. Geriatric Sensitivity – Elderly may exhibit pronounced somnolence; start 0.5 mg and titrate over 10 days; short‑acting benzodiazepines only if necessary.
4. Metabolic “SCOOP” Mnemonic – Sugar (glucose), Choles (lipids), Obesity (BMI), Order (BP), Pulse; reassess each visit.
5. Taper Plan – If discontinued, taper 0.5 mg every 5–7 days to avoid rebound psychosis.
6. Lithium Adjunct – Combining with lithium in bipolar maintenance can improve mood, but monitor lithium levels biweekly during initiation.
7. Missed Dose – Due to long half‑life, a single missed dose can be safely skipped; no “rescue” dose required.
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• Structured H1–H2 hierarchy for readability.
• Bullet points and tables for quick reference.
This drug card offers a concise, reference‑friendly overview for medical students and health‑care professionals.