Restarting Latuda After 1-Month Abrupt Discontinuation
When restarting lurasidone (Latuda) after a 1-month abrupt discontinuation, begin at the standard starting dose of 20 mg once daily with food, exactly as if initiating treatment for the first time. 1
Dosing Protocol for Reinitiation
- Start at 20 mg once daily for patients with bipolar depression (the most common indication), taken with at least 350 calories of food to ensure proper absorption 1
- No initial dose titration is required when starting or restarting lurasidone 1
- After one week, the dose may be increased based on clinical response, with the effective range being 20-120 mg/day for adults 1
Critical Administration Requirements
- Lurasidone must be taken with food (at least 350 calories) because administration with food increases absorption approximately 2-fold (AUC) and 3-fold (Cmax) compared to fasting 1, 2, 3
- The medication should be given once daily, preferably at the same time each day 1
Rationale for Starting Dose Approach
After a 1-month discontinuation, lurasidone will be completely eliminated from the system (half-life is approximately 18 hours), so there is no residual drug effect 4. The FDA labeling makes no distinction between initial treatment and reinitiation after discontinuation—both scenarios use the same starting dose of 20 mg daily 1. This approach:
- Minimizes risk of adverse effects, particularly akathisia, somnolence, nausea, and parkinsonism, which are dose-related and most common early in treatment 4, 2, 5
- Allows reassessment of tolerability, as the patient's sensitivity may have changed during the medication-free period 5
- Follows the established safety profile from clinical trials where 40 mg was the starting dose for schizophrenia, but 20 mg is recommended for bipolar depression 1
Dose Adjustments Based on Patient Factors
For patients with renal impairment (creatinine clearance 30-50 mL/min or <30 mL/min), start at 20 mg daily and do not exceed 80 mg/day 1
For patients with hepatic impairment:
- Moderate impairment (Child-Pugh 7-9): Start at 20 mg daily, maximum 80 mg/day 1
- Severe impairment (Child-Pugh 10-15): Start at 20 mg daily, maximum 40 mg/day 1
Common Pitfalls to Avoid
- Do not restart at the patient's previous maintenance dose, as this increases risk of acute adverse effects, particularly akathisia and extrapyramidal symptoms 4, 2
- Do not administer without food, as bioavailability will be inadequate and therapeutic effect compromised 1, 3
- Do not co-administer with strong CYP3A4 inhibitors (ketoconazole) or inducers (rifampin), as these are contraindicated 1, 3
Monitoring During Reinitiation
- Assess for akathisia and extrapyramidal symptoms within the first 1-2 weeks, as these are the most common early adverse effects 4, 2, 5
- Monitor for somnolence and nausea, which typically occur early in treatment 2, 5
- Evaluate therapeutic response after 1 week to determine if dose escalation is needed 1
- Check for metabolic effects, though lurasidone has minimal impact on weight, glucose, and lipids compared to other antipsychotics 4, 2, 5, 3