What is the recommended dose of Latuda (lurasidone) for treating bipolar depression?

Lurasidone (Latuda) Dosing for Bipolar Depression

For adults with bipolar depression, the recommended starting dose of Latuda (lurasidone) is 20 mg once daily, with an effective dose range of 20-120 mg daily taken with food (at least 350 calories). 1

Dosing Guidelines for Adults

• Starting dose: 20 mg once daily
• Effective dose range: 20-120 mg once daily
• Maximum recommended dose: 120 mg daily
• Administration: Must be taken with food (at least 350 calories) to substantially increase absorption (increases AUC approximately 2-fold and Cmax approximately 3-fold) 1
• Titration: Initial dose titration is not required, but dose may be adjusted based on clinical response
• Important note: Higher dose range (80-120 mg/day) did not provide additional efficacy on average compared to lower dose range (20-60 mg/day) in monotherapy studies 1

Dosing Guidelines for Pediatric Patients (10-17 years)

• Starting dose: 20 mg once daily
• Effective dose range: 20-80 mg once daily
• Maximum recommended dose: 80 mg daily
• Titration: Dose may be increased after one week based on clinical response
• Clinical practice note: Most pediatric patients (67%) received 20 mg or 40 mg once daily in clinical studies 1

Dose Modifications

Renal Impairment

• Moderate impairment (CrCl 30-50 mL/min): Start at 20 mg/day, maximum 80 mg/day
• Severe impairment (CrCl <30 mL/min): Start at 20 mg/day, maximum 80 mg/day 1

Hepatic Impairment

• Moderate impairment (Child-Pugh Score 7-9): Start at 20 mg/day, maximum 80 mg/day
• Severe impairment (Child-Pugh Score 10-15): Start at 20 mg/day, maximum 40 mg/day 1

Drug Interactions

• Strong CYP3A4 inhibitors: Contraindicated (e.g., ketoconazole, clarithromycin, ritonavir)
• Moderate CYP3A4 inhibitors: Reduce dose to half of original dose (maximum 80 mg/day) 1

Efficacy and Safety Profile

• Lurasidone has demonstrated efficacy for bipolar depression as both monotherapy and adjunctive therapy with lithium or valproate 2, 3

• Common side effects include:

  • Akathisia (most common)
  • Somnolence
  • Extrapyramidal symptoms
  • Nausea and gastrointestinal upset 2

• Advantages over other antipsychotics:

  • Minimal weight gain
  • Favorable metabolic profile with minimal changes in glucose and lipids
  • No clinically meaningful QTc prolongation 3, 4

Duration of Treatment

• The effectiveness of lurasidone for longer-term use (beyond 6 weeks) has not been established in controlled studies
• Physicians should periodically re-evaluate the long-term usefulness of the drug for individual patients 1
• Long-term treatment (28 weeks) has shown continued improvement in depressive symptoms with good tolerability 5

Clinical Pearls and Pitfalls

• Critical requirement: Must be taken with food (at least 350 calories) for proper absorption
• Common pitfall: Failure to recognize that higher doses (80-120 mg) may not provide additional efficacy over lower doses (20-60 mg) for most patients
• Safety advantage: Minimal impact on weight and metabolic parameters makes lurasidone a good option for patients with metabolic concerns
• Monitoring: Regular assessment of extrapyramidal symptoms, particularly akathisia, is important

Lurasidone represents a valuable treatment option for bipolar depression with a favorable metabolic profile compared to many other antipsychotics, making it particularly suitable for patients with metabolic concerns or those who cannot tolerate weight gain associated with other medications.