Lurasidone
Generic Name: Lurasidone
Brand Names: Latuda
Lurasidone is an atypical antipsychotic used for schizophrenia and bipolar depression with a favorable metabolic profile.
Drug Class
Atypical Antipsychotic (Second-Generation Antipsychotic)
Pregnancy
Not recommended during pregnancy unless clearly necessary. Third trimester use may cause extrapyramidal symptoms and withdrawal symptoms in the newborn. Enroll exposed patients in the National Pregnancy Registry for Atypical Antipsychotics.
Available Forms
Tablet
What It's Used For
Dosage Quick Reference
These are general dosage guidelines. Your doctor will determine the appropriate dose for your specific situation.
| Condition | Starting Dose | Maintenance Dose |
|---|---|---|
| Schizophrenia (Adults) | 40 mg once daily with food (≥350 calories) | 40–160 mg once daily |
| Schizophrenia (Adolescents 13–17) | 40 mg once daily with food | 40–80 mg once daily |
| Bipolar I Depression (Adults, Monotherapy) | 20 mg once daily with food | 20–120 mg once daily |
| Bipolar I Depression (Adults, Adjunct with lithium or valproate) | 20 mg once daily with food | 20–120 mg once daily |
Side Effects
Common Side Effects:
- Somnolence and sedation
- Akathisia (restlessness)
- Nausea
- Parkinsonism (tremor, rigidity)
- Agitation
Serious Side Effects:
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- Metabolic syndrome
- Orthostatic hypotension
- Agranulocytosis
Drug Interactions
Major Interactions:
- Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, ritonavir, voriconazole) — Contraindicated; dramatically increase lurasidone levels, raising the risk of serious adverse effects
- Strong CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin, St. John’s Wort) — Contraindicated; substantially reduce lurasidone levels, rendering it ineffective
- Moderate CYP3A4 inhibitors (e.g., diltiazem, erythromycin, fluconazole, grapefruit juice) — Lurasidone dose should not exceed 80 mg/day; monitor for increased side effects
- CNS depressants (e.g., alcohol, benzodiazepines, opioids) — Additive sedation and cognitive impairment; use caution
- Antihypertensive medications — Lurasidone can cause orthostatic hypotension; enhanced hypotensive effect when combined with blood-pressure-lowering drugs
Additional Information
Lurasidone is an atypical antipsychotic medication approved for the treatment of schizophrenia and bipolar depression. It offers a favorable metabolic profile compared to many other second-generation antipsychotics, making it an attractive option for patients requiring long-term antipsychotic therapy.
Mechanism of Action
Lurasidone functions as an antagonist at multiple receptor types:
- Dopamine D2 receptors: Primary mechanism for antipsychotic effects
- Serotonin 5-HT2A receptors: Contributes to reduced extrapyramidal symptoms
- Serotonin 5-HT7 receptors: May contribute to antidepressant and procognitive effects
- Alpha-2C adrenergic receptors: May enhance cognitive function
The drug has minimal affinity for histamine H1 and muscarinic M1 receptors, which accounts for its favorable metabolic and anticholinergic profile.
Available Formulations
Lurasidone is available as oral tablets:
- 20 mg tablets
- 40 mg tablets
- 60 mg tablets
- 80 mg tablets
- 120 mg tablets
All tablets should be taken with food (at least 350 calories) to ensure adequate absorption.
Medical Uses
FDA-Approved Indications:
- Schizophrenia in adults and adolescents (13-17 years)
- Bipolar depression (depressive episodes associated with bipolar I disorder) as monotherapy or adjunctive therapy with lithium or valproate in adults
- Bipolar depression in children and adolescents (10-17 years)
Lurasidone is particularly valuable for bipolar depression given limited treatment options for this phase of the illness.
Dosing Guidelines
Schizophrenia (Adults):
- Starting dose: 40 mg once daily
- Recommended range: 40-160 mg once daily
- Maximum: 160 mg/day
Schizophrenia (Adolescents 13-17 years):
- Starting dose: 40 mg once daily
- Recommended range: 40-80 mg once daily
- Maximum: 80 mg/day
Bipolar Depression:
- Starting dose: 20 mg once daily
- Recommended range: 20-120 mg once daily (monotherapy) or 20-80 mg (adjunctive)
Important Safety Information
Black Box Warnings:
- Increased risk of death in elderly patients with dementia-related psychosis
- Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults
Contraindications:
- Known hypersensitivity to lurasidone
- Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole) or inducers (e.g., rifampin)
Warnings and Precautions:
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- Metabolic changes (monitor weight, glucose, lipids)
- Orthostatic hypotension
- Leukopenia and neutropenia
- Seizures
Drug Interactions
- Strong CYP3A4 inhibitors (ketoconazole, clarithromycin): Contraindicated
- Strong CYP3A4 inducers (rifampin, carbamazepine): Contraindicated
- Moderate CYP3A4 inhibitors (diltiazem): Reduce lurasidone dose by half
- Grapefruit and grapefruit juice: Avoid
Special Populations
- Hepatic Impairment: Reduce dose; maximum 80 mg/day for moderate impairment, 40 mg/day for severe
- Renal Impairment: Maximum 80 mg/day for moderate to severe impairment
- Elderly: Use lower starting doses
- Pregnancy: May cause extrapyramidal symptoms and withdrawal in neonates
Frequently Asked Questions
Questions to Ask Your Doctor
Consider discussing these topics at your next appointment:
- ✓Ask your doctor about regular blood tests to monitor fasting blood sugar, cholesterol, and triglycerides during treatment.
- ✓Discuss any medications you take that may be CYP3A4 inhibitors or inducers, as these are contraindicated with lurasidone.
- ✓Ask about signs of tardive dyskinesia (involuntary movements) and neuroleptic malignant syndrome, which are rare but serious side effects.
- ✓Discuss whether lurasidone is appropriate if you have a history of seizures, cardiovascular disease, or diabetes.
- ✓Ask how long you should remain on lurasidone and what the plan is for monitoring your response.
Related Health Conditions
This medication is commonly used to treat or manage the following conditions:
Medical Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. Your doctor can provide personalized recommendations based on your specific health condition and medical history.
Related Medications
Other medications in the same category
Questions About This Medication?
Talk to your doctor or pharmacist about whether Lurasidone is right for you.
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