What is the next dose increase for Latuda (lurasidone) from 40 mg daily?

Lurasidone (Latuda) Dose Increase from 40 mg Daily

The next dose increase for Latuda (lurasidone) from 40 mg daily is 60 mg daily, taken once daily with food (at least 350 calories). 1

Dosing Guidelines for Lurasidone

• Lurasidone has been shown to be effective in a dose range of 20 mg per day to 120 mg per day for bipolar depression 1
• The recommended starting dose is 40 mg given once daily, with no initial titration required 1
• When increasing from 40 mg, the next appropriate dose is 60 mg daily, followed by 80 mg daily if needed 1, 2
• The maximum recommended dose is 120 mg per day for adults 1
• Doses above 80 mg per day do not appear to provide additional efficacy on average compared to lower doses (20-60 mg per day) in monotherapy studies 1

Administration Requirements

• Lurasidone must be taken with food (at least 350 calories) to optimize absorption 1
• Administration with food increases the AUC approximately 2-fold and increases the Cmax approximately 3-fold 1
• Once-daily dosing is recommended, with no need for divided doses 1, 2

Special Population Considerations

• For patients with moderate renal impairment (creatinine clearance: 30 to <50 mL/min), the dose should not exceed 80 mg per day 1
• For patients with moderate hepatic impairment (Child-Pugh Score = 7 to 9), the dose should not exceed 80 mg per day 1
• For patients with severe hepatic impairment (Child-Pugh Score = 10 to 15), the dose should not exceed 40 mg per day 1

Monitoring and Adverse Effects

• Monitor for common adverse effects when increasing the dose, particularly somnolence, akathisia, nausea, and parkinsonism, which may occur especially early in treatment 3
• Unlike some other antipsychotics, lurasidone is associated with minimal weight gain and no clinically meaningful alterations in glucose, lipids, or QTc interval 3, 4
• Higher doses may be associated with increased risk of adverse effects, particularly somnolence and akathisia 4, 5

Drug Interactions

• If a moderate CYP3A4 inhibitor (e.g., diltiazem, atazanavir, erythromycin, fluconazole, verapamil) is added to therapy, the lurasidone dose should be reduced to half of the original dose 1
• Lurasidone should not be used concomitantly with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, ritonavir) 1

Long-term Considerations

• The effectiveness of lurasidone for longer-term use (more than 6 weeks) has not been established in controlled studies 1
• Periodic re-evaluation of the long-term usefulness of the medication for the individual patient is recommended 1