Lurasidone (Latuda)

Contents

Clinical Information

 

HALF-LIFE: 18-31 hours

METABOLISM: Substrate of CYP3A4

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.

Side Effects

  • Akathisia, Somnolence, Extrapyramidal Symptoms, Nausea, Upset Stomach, Diarrhea

Drug Interactions

  • Inducers of CYP3A4 (Carbamazepine) will lower Lurasidone levels
  • Inhibitors of CYP3A4 (Grapefruit Juice) will increase Lurasidone levels

FDA Indications

  1. Schizophrenia, 13yo and older
  2. Bipolar Depression

Mechanism(s) of Action

  • Dopamine 2 (D2) Receptor Antagonist, 5HT2 Receptor Antagonist, 5HT7 Receptor Antagonist, 5HT1A Receptor Partial Agonist.

Additional Information

  • Little or no weight gain or dyslipidemia
  • Moderate risk for extrapyramidal symptoms (parkinsonism, dystonia) but this can be reduced if given at night
  • Take with 350 calorie meal
  • No QTc prolongation
  • Robust evidence for efficacy in bipolar depression

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.