What is the recommended dosing for Latuda (lurasidone)?

Lurasidone (Latuda) Dosing Recommendations

For adult patients with schizophrenia or bipolar depression, the recommended starting dose of Latuda (lurasidone) is 40 mg once daily, with a maximum recommended dose of 80 mg daily. 1

General Dosing Guidelines

• The recommended starting dose for adults is 40 mg once daily 1, 2
• No initial dose titration is required 1
• Latuda should always be taken with food (at least 350 calories) as administration with food substantially increases absorption by approximately 2-fold for AUC and 3-fold for Cmax 1, 2
• The maximum recommended dose is 80 mg daily for most patients 1, 2
• Higher doses (up to 120 mg) are approved but do not appear to provide additional efficacy on average and may increase risk of adverse effects 1, 3

Special Populations

Renal Impairment

• For moderate (CrCl 30-50 mL/min) or severe (CrCl <30 mL/min) renal impairment:
  • Starting dose: 20 mg once daily
  • Maximum dose: 80 mg once daily 1

Hepatic Impairment

• For moderate hepatic impairment (Child-Pugh Score 7-9):
  • Starting dose: 20 mg once daily
  • Maximum dose: 80 mg once daily 1
• For severe hepatic impairment (Child-Pugh Score 10-15):
  • Starting dose: 20 mg once daily
  • Maximum dose: 40 mg once daily 1

Drug Interactions

• Latuda should not be used with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, ritonavir) 1
• With moderate CYP3A4 inhibitors (e.g., diltiazem, erythromycin):
  • Reduce Latuda dose to half the original dose 1
  • If starting Latuda while on a moderate inhibitor: start at 20 mg daily with maximum of 80 mg daily 1
• Avoid grapefruit and grapefruit juice as they may inhibit CYP3A4 1
• Latuda should not be used with strong CYP3A4 inducers (e.g., rifampin, St. John's wort, phenytoin) 1
• With moderate CYP3A4 inducers, dose increases may be necessary after chronic treatment (≥7 days) 1

Efficacy and Safety Considerations

• Recent evidence suggests that 80 mg may be the optimal starting dose for efficacy in schizophrenia, with the option to increase to 160 mg as needed 4
• Common adverse effects include somnolence, akathisia, nausea, and parkinsonism, particularly early in treatment 3, 5, 6
• Latuda has a favorable metabolic profile with minimal weight gain and no clinically meaningful alterations in glucose, lipids, or ECG QT interval 3, 6, 2
• Higher doses (120-160 mg) are associated with increased risk of akathisia and somnolence 4, 2

Bipolar Depression Dosing

• For adults with bipolar depression:
  • Starting dose: 20 mg once daily (monotherapy or adjunctive with lithium/valproate)
  • Effective dose range: 20-120 mg daily
  • Maximum recommended dose: 120 mg daily 1
• For pediatric patients (10-17 years) with bipolar depression:
  • Starting dose: 20 mg once daily (monotherapy)
  • Maximum recommended dose: 80 mg daily 1

Administration Pearls

• Always administer with food containing at least 350 calories 1
• Once daily dosing 1
• For long-term use beyond 6 weeks, periodically re-evaluate the usefulness of the medication 1