Lurasidone (Latuda)

 HALF-LIFE: 18-31 hours
STARTING DOSE: 20mg-40mg PO daily with food
TARGET DOSING RANGE: 20mg-80mg per day
BEST TIME TO DOSE: Bedtime
HOW TO DOSE:
>> Schizophrenia: Initial 40mg PO daily with food (350 calories)
Increase dose up to 160mg PO daily if tolerated.
>> Bipolar depression: Initial 20mg PO daily with food (350 calories)
Increase dose up to 120mg PO daily if tolerated
PREGNANCY: Minimal data on safety.
BREASTFEEDING: Minimal data on safety.
FDA INDICATIONS:
1) Schizophrenia, 13yo and older
2) Bipolar Depression

ADDITIONAL INFORMATION

  • High affinity for 5HT7 and 5HT2A
    • Antidepressant potential likely due to 5HT7 receptors
    • 5HT7 receptors located on GABA interneurons in raphe nuclei and Prefrontal cortex stimulate the GABA interneurons to inhibit serotonin release and glutamate release
    • Blocking 5HT7 receptors stimulate serotonin and glutamate release
  • Moderate affinity for 5HT1A and α2 receptors
  • Minimal affinity for H1-histamine and M1-cholinergic receptors
  • Little or no weight gain or dyslipidemia
  • Moderate EPS, but reduced if given at night
  • Take with 350 calorie meal as Cmax and bioavailability are reduced without food
  • No QTc prolongation
  • Robust evidence for efficacy in bipolar depression
  • Metabolized by CYP3A4

References:

  1. Cooper, J. R., Bloom, F. E., & Roth, R. H. (2003). The biochemical basis of neuropharmacology (8th ed.). New York, NY, US: Oxford University Press.
  2. Iversen, L. L., Iversen, S. D., Bloom, F. E., & Roth, R. H. (2009). Introduction to neuropsychopharmacology. Oxford: Oxford University Press.
  3. Puzantian, T., & Carlat, D. J. (2016). Medication fact book: for psychiatric practice. Newburyport, MA: Carlat Publishing, LLC.
  4. J. Ferrando, J. L. Levenson, & J. A. Owen (Eds.), Clinical manual of psychopharmacology in the medically ill(pp. 3-38). Arlington, VA, US: American Psychiatric Publishing, Inc.
  5. Schatzberg, A. F., & DeBattista, C. (2015). Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Publishing.
  6. Schatzberg, A. F., & Nemeroff, C. B. (2017). The American Psychiatric Association Publishing textbook of psychopharmacology. Arlington, VA: American Psychiatric Association Publishing.
  7. Stahl, S. M. (2014). Stahl’s essential psychopharmacology: Prescriber’s guide (5th ed.). New York, NY, US: Cambridge University Press.
  8. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY, US: Cambridge University Press.
  9. Whalen, K., Finkel, R., & Panavelil, T. A. (2015). Lippincotts illustrated reviews: pharmacology. Philadelphia, PA: Wolters Kluwer.

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