Latuda (Lurasidone) Dosing Recommendations
Standard Dosing for Bipolar Depression
For adults with bipolar depression, start Latuda at 20 mg once daily and titrate to a target range of 20-120 mg per day, while for pediatric patients (10-17 years), use the same starting dose of 20 mg daily but limit the maximum to 80 mg per day. 1
Key Administration Requirements
Latuda must be taken with food (at least 350 calories) as this substantially increases absorption and bioavailability. 1, 2 This is a critical requirement that directly impacts efficacy.
No initial dose titration is required—patients can remain at the starting dose or adjust based on response and tolerability. 1
Dosing Adjustments for Special Populations
Renal Impairment
- For moderate to severe renal impairment, reduce the starting dose to 20 mg per day with a maximum of 80 mg per day. 1 This applies to both schizophrenia and bipolar depression indications.
Hepatic Impairment
- Moderate hepatic impairment: Start at 20 mg daily, maximum 80 mg per day 1
- Severe hepatic impairment: Start at 20 mg daily, maximum 40 mg per day 1
Elderly Patients
- While the FDA label does not specify separate dosing for elderly patients, consider starting at lower doses (20 mg) given the increased risk of adverse effects in this population, similar to recommendations for other atypical antipsychotics. 3
Drug Interaction Adjustments
Moderate CYP3A4 Inhibitors (e.g., diltiazem)
- Reduce the Latuda dose to half of the original level when co-administered with moderate CYP3A4 inhibitors. 1
- Starting dose should be 20 mg daily with a maximum of 80 mg per day. 1
Strong CYP3A4 Inhibitors and Inducers
- Latuda is contraindicated with strong CYP3A4 inhibitors (e.g., ketoconazole) and strong CYP3A4 inducers (e.g., rifampin). 1 Do not use these combinations.
Moderate CYP3A4 Inducers
- It may be necessary to increase the Latuda dose when co-administered with moderate CYP3A4 inducers, though specific dose adjustments are not provided. 1
Pharmacokinetic Profile
- Peak plasma concentrations occur in 1-3 hours after administration 2
- Mean elimination half-life is approximately 18 hours, supporting once-daily dosing 2
- Approximately 99% protein-bound 2
- Dose-proportional pharmacokinetics within the approved dosing range 2
Common Adverse Effects to Monitor
Adults with Bipolar Depression
- Akathisia, extrapyramidal symptoms, and somnolence occur at rates ≥5% and at least twice the placebo rate 1
Pediatric Patients (10-17 years)
- Nausea, weight increase, and insomnia are the most common adverse effects 1
Critical Safety Considerations
Black box warning for increased mortality in elderly patients with dementia-related psychosis—Latuda is not approved for this indication. 1
Black box warning for suicidal thoughts and behaviors in pediatric and young adult patients—close monitoring is required. 1
Monitor for metabolic changes including hyperglycemia, dyslipidemia, and weight gain, though Latuda has a favorable metabolic profile compared to some other atypical antipsychotics. 1, 4, 5
Monitor for orthostatic hypotension, particularly in patients with cardiovascular disease or risk of dehydration. 1