What laboratory tests should be checked for a patient starting on Latuda (lurasidone)?

Laboratory Testing for Latuda (Lurasidone)

Before starting Latuda, obtain fasting blood glucose (or HbA1c), lipid profile, complete blood count, comprehensive metabolic panel including liver function tests, BMI, waist circumference, blood pressure, prolactin level, and electrocardiogram. 1, 2

Baseline Laboratory Tests Required

The following tests should be obtained before initiating Latuda:

• Metabolic parameters: Fasting blood glucose or HbA1c to assess diabetes risk, as atypical antipsychotics including lurasidone are associated with hyperglycemia 1, 2
• Lipid profile: Total cholesterol, LDL, HDL, and triglycerides to establish baseline for monitoring metabolic changes 1
• Complete blood count (CBC): To evaluate baseline hematologic parameters, particularly important given the risk of low white blood cell count with antipsychotics 1, 2
• Comprehensive metabolic panel: Including liver function tests (ALT, AST, alkaline phosphatase, bilirubin), blood urea nitrogen, serum creatinine, and electrolytes (sodium, potassium, calcium, magnesium) 1
• Prolactin level: To establish baseline, as lurasidone can cause hyperprolactinemia 2
• Electrocardiogram (ECG): To assess baseline cardiac parameters, though lurasidone does not typically prolong QTc interval 1, 3
• Body measurements: BMI and waist circumference to monitor for weight gain 1
• Blood pressure: To establish baseline cardiovascular parameters 1
• Pregnancy test: For women of childbearing potential before initiating therapy 1

Monitoring Schedule During Treatment

First 6 Weeks

• Weekly monitoring: BMI, waist circumference, and blood pressure should be checked weekly for the first 6 weeks 1

At 4 Weeks

• Fasting glucose: Re-check 4 weeks following initiation; if fasting sample cannot be obtained, a random sample can be used as initial screening, then prioritize fasting measure if not in healthy range 1

At 3 Months

• Comprehensive reassessment: Repeat all baseline measures (BMI, waist circumference, blood pressure, HbA1c, glucose, lipids, prolactin, liver function tests, urea and electrolytes, full blood count) 1

Ongoing Monitoring

• Annual testing: All metabolic parameters should be repeated annually thereafter 1
• Blood tests during first few months: White blood cell count monitoring may be performed during the first few months of treatment 2

Critical Clinical Considerations

Lurasidone has a favorable metabolic profile compared to many other atypical antipsychotics, with minimal weight gain and no clinically meaningful alterations in glucose, lipids, or ECG QTc interval. 3, 4 This makes it particularly suitable for patients who are overweight or have endocrine problems (diabetes, dyslipidemia) or comorbid cardiovascular conditions 3.

The most common adverse effects include somnolence, akathisia, nausea, and parkinsonism, especially early in treatment 3, 4. However, the rates of metabolic syndrome for patients taking lurasidone are comparable to placebo groups 5.

Common Pitfalls to Avoid

• Failure to obtain baseline values: Without baseline measurements, it becomes impossible to determine whether abnormalities are treatment-emergent or pre-existing 1
• Inadequate frequency of weight monitoring: The first 6 weeks require weekly monitoring when metabolic changes are most likely to emerge 1
• Missing pregnancy screening: Always perform pregnancy testing in women of childbearing potential before initiation 1
• Not checking prolactin levels: Hyperprolactinemia can cause significant symptoms including menstrual irregularities in females and erectile dysfunction in males 2
• Overlooking signs of hyperprolactinemia: Monitor for absence of menstrual cycle, breast milk secretion (females), erectile dysfunction, and gynecomastia (males) 2