Lurasidone Dosing
Recommended Dosing for Bipolar Depression
For adults with bipolar depression, start lurasidone at 20 mg once daily (either as monotherapy or adjunctive to lithium/valproate), with an effective dose range of 20-120 mg/day and a maximum dose of 120 mg/day. 1
Adult Dosing (Bipolar Depression)
- Starting dose: 20 mg once daily 1
- No initial titration required 1
- Effective range: 20-120 mg/day 1
- Maximum dose: 120 mg/day 1
- Important note: In monotherapy studies, higher doses (80-120 mg/day) did not provide additional efficacy compared to lower doses (20-60 mg/day) 1
Pediatric Dosing (Ages 10-17, Bipolar Depression)
- Starting dose: 20 mg once daily as monotherapy 1
- Dose adjustment: May increase after one week based on clinical response 1
- Effective range: 20-80 mg/day 1
- Maximum dose: 80 mg/day 1
- Clinical context: Most patients (67%) in trials received 20-40 mg once daily 1
Recommended Dosing for Schizophrenia
For schizophrenia, the recommended starting dose is 40 mg once daily, with an effective range of 40-160 mg/day, though the FDA-labeled maximum is 80 mg/day. 1, 2
Standard Schizophrenia Dosing
- Starting dose: 40 mg once daily 1, 3
- No initial titration required 3
- FDA-labeled range: 40-80 mg/day 1, 4
- Extended range: Recent evidence supports doses up to 160 mg/day 2, 5
- Efficacy considerations: Doses of 80-160 mg show superior efficacy compared to 40 mg, with 160 mg demonstrating the best efficacy-safety balance for acute schizophrenia 5
Critical Administration Requirements
Lurasidone must be taken with food containing at least 350 calories to ensure adequate absorption. 1
- Food requirement: At least 350 calories 1
- Pharmacokinetic impact: Food increases AUC approximately 2-fold and Cmax approximately 3-fold 1
- Clinical implication: All efficacy studies administered lurasidone with food 1
Dose Modifications for Special Populations
Renal Impairment
- Moderate impairment (CrCl 30-<50 mL/min): Start at 20 mg/day, maximum 80 mg/day 1
- Severe impairment (CrCl <30 mL/min): Start at 20 mg/day, maximum 80 mg/day 1
Hepatic Impairment
- Moderate impairment (Child-Pugh 7-9): Start at 20 mg/day, maximum 80 mg/day 1
- Severe impairment (Child-Pugh 10-15): Start at 20 mg/day, maximum 40 mg/day 1
Drug Interactions
- Strong CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir): Contraindicated—do not use together 1, 3
- Moderate CYP3A4 inhibitors (diltiazem, erythromycin, fluconazole): Reduce lurasidone dose to half the original level 1
- Strong CYP3A4 inducers (rifampin): Contraindicated 3
Common Pitfalls and Safety Considerations
Most Common Adverse Effects
- Akathisia, nausea, somnolence, and extrapyramidal symptoms are most common at doses of 80-120 mg/day 5
- Dose-dependent effects: Somnolence and akathisia increase with doses above 80 mg/day 2, 4
- Early treatment: These effects are especially prominent early in treatment 6
Metabolic Advantages
- Minimal weight gain compared to other atypical antipsychotics 2, 3, 6
- No clinically meaningful alterations in glucose, lipids, or ECG QTc interval 2, 3, 6
- Preferred option for patients with obesity, diabetes, dyslipidemia, or cardiovascular comorbidities 6