Lurasidone (Latuda): Dosage and Usage for Schizophrenia and Bipolar Depression
For treating schizophrenia and bipolar depression, lurasidone (Latuda) should be administered at a starting dose of 20mg once daily with food (at least 350 calories), with recommended dose ranges of 40-160mg daily for schizophrenia in adults and 20-120mg daily for bipolar depression in adults. 1
Dosing Guidelines
Schizophrenia
- Starting dose: 40mg once daily
- Effective dose range: 40-160mg once daily
- Maximum recommended dose: 160mg once daily
- Administration: Must be taken with food (at least 350 calories)
Bipolar Depression
Adults:
- Starting dose: 20mg once daily
- Effective dose range: 20-120mg once daily
- Maximum recommended dose: 120mg once daily
- Note: In monotherapy studies, higher doses (80-120mg) did not provide additional efficacy compared to lower doses (20-60mg) 1
Pediatric patients (10-17 years):
- Starting dose: 20mg once daily
- Effective dose range: 20-80mg once daily
- Maximum recommended dose: 80mg once daily
- Note: Most pediatric patients (67%) in clinical studies received 20-40mg daily 1
Special Dosing Considerations
Renal Impairment
- Moderate to severe impairment:
- Starting dose: 20mg daily
- Maximum dose: 80mg daily 1
Hepatic Impairment
- Moderate impairment:
- Starting dose: 20mg daily
- Maximum dose: 80mg daily
- Severe impairment:
- Starting dose: 20mg daily
- Maximum dose: 40mg daily 1
Drug Interactions
- Strong CYP3A4 inhibitors: Concomitant use contraindicated
- Moderate CYP3A4 inhibitors: Reduce lurasidone dose to half of original dose
- CYP3A4 inducers: May require dose increase 1
Administration Requirements
The absorption of lurasidone is highly dependent on food intake:
- Must be taken with food (at least 350 calories)
- Food increases AUC approximately 2-fold
- Food increases Cmax approximately 3-fold 1
Efficacy Profile
Schizophrenia
- Efficacy established in five 6-week, fixed-dose, randomized, placebo-controlled trials 2
- Effective for reducing positive psychotic symptoms
- Requires 4-6 weeks for adequate therapeutic trial 3
Bipolar Depression
- Effective as monotherapy and as adjunctive therapy with lithium or valproate 1
- Shows unusual efficacy in acute bipolar depression even without psychotic features 4
- Trials of adding lurasidone to lithium or valproate have yielded inconsistent findings 4
Safety and Side Effect Profile
Common Side Effects
Metabolic Profile
- Minimal weight gain
- No clinically meaningful alterations in glucose or lipids
- No significant QTc interval prolongation 2
- Rates of metabolic syndrome comparable to placebo groups 5
Monitoring Requirements
- Regular monitoring for emergence of extrapyramidal symptoms
- Monitoring for hyperprolactinemia
- Periodic reassessment for long-term use (efficacy beyond 6 weeks not established in controlled studies) 1
Clinical Pearls
- Initial dose titration is not required for either schizophrenia or bipolar depression
- The once-daily dosing regimen improves adherence
- Principal advantage over some other second-generation antipsychotics is lurasidone's highly favorable metabolic profile 2
- Mechanism of action may involve antagonism of the serotonin 7 receptor 6
- For bipolar depression, consider as an alternative to olanzapine-fluoxetine combination which has more metabolic side effects 7
Lurasidone represents an important treatment option for both schizophrenia and bipolar depression with its favorable metabolic profile and once-daily dosing regimen, though clinicians should be vigilant about monitoring for akathisia which may be more common than with other atypical antipsychotics.