Lurasidone (Latuda) Dose Titration Guidelines
When starting a patient on lurasidone 20mg daily, you should wait at least one week before considering a dose increase to allow for initial assessment of tolerability and early response.
Initial Dosing and Titration Strategy
Starting Dose
- Initial recommended dose: 40mg once daily with food 1
- For some patients, starting at 20mg daily may be appropriate to assess initial tolerability
Titration Schedule
- Wait at least one week before increasing the dose from 20mg
- Dose increases should be made in increments of the initial dose 2
- No initial dose titration is required when starting at the recommended 40mg dose 1
Target Dosing
- Effective dose range: 40-160mg once daily 1
- Dose adjustments should be based on clinical response and tolerability
- Maximum recommended daily dose is 160mg
Monitoring During Titration
First Week Assessment (Before Considering Dose Increase)
Ongoing Monitoring
- Complete blood count with differential (monitor for potential hematologic effects) 4
- Metabolic parameters (lurasidone has favorable metabolic profile compared to other antipsychotics) 3
- Extrapyramidal symptoms assessment
- Clinical response evaluation
Special Considerations
Administration Requirements
- Must be taken with food (at least 350 calories) for optimal absorption 1
- Consistent timing of administration is recommended
Drug Interactions
- Avoid concomitant use with strong CYP3A inhibitors (contraindicated) 5
- If previously on a strong CYP3A inhibitor, normal-weight patients should limit lurasidone dosage for two weeks after discontinuation of the inhibitor 5
- Obese patients may require longer washout periods (three weeks) after CYP3A inhibitor discontinuation 5
Clinical Pearls
- Lurasidone has a favorable weight and metabolic profile compared to many other antipsychotics 3
- No cardiovascular adverse effects such as orthostatic hypotension or QTc prolongation 3
- Early adverse effects like akathisia and somnolence often emerge in the first week of treatment, making this initial assessment period crucial 1, 3
- Long-acting injectable formulations are being investigated but are not currently available 6
While the standard recommended starting dose is 40mg daily, starting at 20mg and increasing after one week allows for assessment of tolerability while still achieving therapeutic dosing in a timely manner.