Starting Dose of Lurasidone (Latuda) for Adults
The recommended starting dose of lurasidone (Latuda) for adults is 20 mg once daily, taken with food (at least 350 calories). 1
Dosing Guidelines
- Lurasidone should be taken with food containing at least 350 calories, as food substantially increases absorption (approximately 2-fold increase in AUC and 3-fold increase in Cmax) 1
- No initial dose titration is required when starting lurasidone 1
- The effective dose range for adults is 20-120 mg per day 1
- The maximum recommended dose is 120 mg per day 1
Special Population Considerations
- Renal Impairment: For patients with moderate (CrCl 30-50 mL/min) or severe (CrCl <30 mL/min) renal impairment, the recommended starting dose is 20 mg per day with a maximum dose of 80 mg per day 1
- Hepatic Impairment: For patients with moderate (Child-Pugh score 7-9) or severe (Child-Pugh score 10-15) hepatic impairment, the recommended starting dose is 20 mg per day with a maximum dose of 80 mg per day for moderate impairment and 40 mg per day for severe impairment 1
- Concomitant Medications: When used with moderate CYP3A4 inhibitors (e.g., diltiazem), the lurasidone dose should be reduced to half of the original dose, with a recommended starting dose of 20 mg per day 1
Clinical Considerations
- Lurasidone has been shown to be effective in the treatment of schizophrenia and bipolar depression 1, 2
- The most commonly reported adverse events include somnolence, akathisia, nausea, and parkinsonism 3, 4
- Lurasidone has a favorable metabolic profile with minimal weight gain and no clinically meaningful alterations in glucose, lipids, or QTc interval 3, 5
- Higher doses (above 80 mg/day) may not provide additional efficacy and may increase the risk of adverse effects such as somnolence and akathisia 6, 5
Important Monitoring Parameters
- Monitor for common side effects including somnolence, akathisia, nausea, and parkinsonism, especially early in treatment 4
- Assess metabolic parameters (weight, glucose, lipids) periodically, although changes are typically minimal 3
- Evaluate the long-term usefulness of the medication periodically if used beyond 6 weeks, as the effectiveness for longer-term use has not been established in controlled studies 1
Clinical Pearl
While some older product information may have listed 40 mg as the starting dose 3, 6, 5, the current FDA-approved labeling clearly recommends 20 mg as the starting dose for adults with schizophrenia or bipolar depression 1. This lower starting dose may help minimize initial side effects while maintaining efficacy.