What is the recommended dosage and treatment guidelines for Latuda (lurasidone) in patients with schizophrenia or bipolar depression?

Recommended Dosage and Treatment Guidelines for Latuda (Lurasidone) in Schizophrenia and Bipolar Depression

For patients with schizophrenia, Latuda (lurasidone) should be administered at 40-160 mg once daily with food (at least 350 calories), with a recommended starting dose of 40 mg/day without initial dose titration. 1, 2

Dosing Guidelines for Schizophrenia

• The recommended starting dose for schizophrenia is 40 mg once daily 1, 2
• Effective dose range is 40-160 mg once daily 1, 2
• Initial dose titration is not required 1
• Must be taken with food (at least 350 calories) as food increases absorption approximately 2-fold and peak concentration 3-fold 1
• Antipsychotic treatment should be continued for at least 12 months after the beginning of remission 3

Dosing Guidelines for Bipolar Depression

• For adults with bipolar depression, the recommended starting dose is 20 mg once daily as monotherapy or as adjunctive therapy with lithium or valproate 1
• Effective dose range for adults is 20-120 mg once daily 1, 4
• For pediatric patients (10-17 years), the recommended starting dose is 20 mg once daily as monotherapy, with a maximum dose of 80 mg/day 1
• In the monotherapy study for adults, the higher dose range (80-120 mg/day) did not provide additional efficacy compared to the lower dose range (20-60 mg/day) 1
• Must be taken with food (at least 350 calories) 1

Special Populations and Dose Modifications

• For patients with moderate renal impairment (creatinine clearance: 30 to <50 mL/min), start with 20 mg/day with a maximum dose of 80 mg/day 1
• For patients with severe renal impairment (creatinine clearance <30 mL/min), start with 20 mg/day with a maximum dose of 80 mg/day 1
• For patients with moderate hepatic impairment (Child-Pugh Score = 7 to 9), start with 20 mg/day with a maximum dose of 80 mg/day 1
• For patients with severe hepatic impairment (Child-Pugh Score = 10 to 15), start with 20 mg/day with a maximum dose of 40 mg/day 1

Drug Interactions

• Latuda should not be used concomitantly with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, ritonavir) 1
• When used with moderate CYP3A4 inhibitors (e.g., diltiazem, atazanavir, erythromycin), the Latuda dose should be reduced to half of the original dose 1
• If starting Latuda in a patient already on a moderate CYP3A4 inhibitor, start with 20 mg/day with a maximum of 80 mg/day 1

Clinical Efficacy and Safety Profile

• Latuda has demonstrated efficacy in multiple 6-week, placebo-controlled trials for schizophrenia 2
• For bipolar depression, Latuda is effective both as monotherapy and as adjunctive therapy with lithium or valproate 1, 5
• Latuda has a favorable metabolic profile with minimal weight gain and no clinically meaningful alterations in glucose, lipids, or ECG QTc interval 2, 4
• Most common adverse events include somnolence, akathisia, nausea, and parkinsonism 2, 4
• Higher rates of akathisia, parkinsonism, and hyperprolactinemia have been observed compared to other atypical antipsychotics 4
• Lower risk for sedation and weight gain compared to some other atypical antipsychotics 4, 6

Long-term Treatment Considerations

• The effectiveness of Latuda for longer-term use (more than 6 weeks) has not been established in controlled studies for bipolar depression 1
• For schizophrenia, long-term studies have demonstrated efficacy in preventing relapse 6
• Physicians should periodically re-evaluate the long-term usefulness of the drug for individual patients 1
• For bipolar disorder maintenance, treatment should continue for at least 2 years after the last episode 3

Important Clinical Considerations

• Anticholinergics should not be used routinely for preventing extrapyramidal side effects but may be considered for short-term use in patients with significant symptoms when dose reduction and switching strategies have proven ineffective 3
• Psychoeducation should be routinely offered to individuals with psychotic and bipolar disorders and their family members/caregivers 3
• Psychosocial interventions to enhance independent living and social skills should be considered as part of comprehensive treatment 3