Does Latuda (lurasidone) have less weight gain compared to divalproex?

Lurasidone Has Less Weight Gain Than Divalproex

Yes, lurasidone (Latuda) has significantly less weight gain compared to divalproex sodium (valproic acid). According to evidence-based guidelines, lurasidone is considered one of the most weight-neutral antipsychotics available, while divalproex is consistently associated with weight gain as a common side effect 1.

Comparative Weight Gain Profiles

Lurasidone (Latuda)

• Appears to be one of the most weight-neutral antipsychotics 1
• Has a favorable NNH (Number Needed to Harm) value of 58 for weight gain of at least 7% from baseline when used as monotherapy 2
• Associated with minimal weight gain in clinical trials 3
• Real-world analysis showed an average weight reduction of 0.77 kg at one year after initiation 4
• Patients who switched from weight gain-promoting antipsychotics to lurasidone experienced an estimated weight loss of 1.68 kg after one year 4

Divalproex (Valproic Acid)

• Consistently associated with weight gain 1
• Listed among anti-epileptic agents with "substantial weight gain" in clinical guidelines 1
• Known adverse effects include weight gain, hair loss, tremor, and teratogenic potential 1
• No specific weight-neutral alternatives within the same class are identified in guidelines 1

Clinical Implications

The weight gain difference between these medications has important clinical implications:

• Metabolic Health: Divalproex-associated weight gain may worsen metabolic parameters, while lurasidone has a favorable profile with respect to metabolic disturbances 3
• Medication Adherence: Weight gain is a common reason for medication discontinuation, making lurasidone potentially advantageous for long-term treatment
• Quality of Life: Weight gain can significantly impact patients' quality of life and self-esteem

Important Considerations and Caveats

1. Combined Therapy Risk: There is case report evidence suggesting that when lurasidone and valproic acid are used together, significant weight gain (10 kg in six months) can occur in some patients 5

2. Individual Variation: While population trends show less weight gain with lurasidone, individual responses may vary

3. Other Side Effect Profiles: When choosing between medications, consider that:

   • Lurasidone's most common side effects include akathisia, extrapyramidal symptoms, and somnolence 3
   • Divalproex's side effects include hair loss, tremor, and teratogenic potential 1

Clinical Decision Algorithm

When choosing between lurasidone and divalproex, consider:

1. Weight concerns: If the patient has obesity, metabolic syndrome, diabetes, or significant concerns about weight gain, lurasidone is clearly preferred

2. Indication: Ensure the medication is appropriate for the specific condition being treated

   • Lurasidone is approved for bipolar depression and schizophrenia
   • Divalproex is approved for bipolar disorder, epilepsy, and migraine prevention

3. Prior response: If the patient has previously responded well to one medication without significant side effects, this may guide decision-making

4. Pregnancy potential: Divalproex has significant teratogenic risks that lurasidone does not have

In summary, the evidence strongly supports that lurasidone has a more favorable weight profile than divalproex, making it a better option for patients with existing weight concerns or metabolic issues.