Latuda (Lurasidone) for Schizophrenia and Bipolar I Depression

Dosing and Administration

Latuda must be taken with food (at least 350 calories) because administration with food substantially increases absorption. 1

Recommended Dosing by Indication

For bipolar depression in adults:

Starting dose: 20 mg once daily 1
Recommended range: 20-120 mg per day 1
No initial titration required 2

For bipolar depression in pediatric patients (10-17 years):

Starting dose: 20 mg once daily 1
Recommended range: 20-80 mg per day 1

For schizophrenia in adults:

Starting dose: 40 mg once daily 1, 2
Recommended range: 40-160 mg per day 1, 2
Once-daily dosing regimen 2

For schizophrenia in adolescents (13-17 years):

Dose range: 20-80 mg per day 3

Dose Adjustments for Special Populations

Moderate to severe renal impairment:

Starting dose: 20 mg per day 1
Maximum dose: 80 mg per day 1

Moderate hepatic impairment:

Starting dose: 20 mg per day 1
Maximum dose: 80 mg per day 1

Severe hepatic impairment:

Starting dose: 20 mg per day 1
Maximum dose: 40 mg per day 1

Concomitant use with moderate CYP3A4 inhibitors (e.g., diltiazem):

Reduce dose to half of original level 1
Starting dose: 20 mg per day 1
Maximum dose: 80 mg per day 1

Concomitant use with moderate CYP3A4 inducers:

May require dose increase 1

Contraindications

Latuda is absolutely contraindicated in three situations:

Known hypersensitivity to lurasidone or any formulation components 1
Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole) 1
Concomitant use with strong CYP3A4 inducers (e.g., rifampin) 1

Monitoring Parameters

Baseline Assessment

Before initiating Latuda, obtain:

Body mass index and waist circumference 4
Blood pressure 4
Fasting glucose 4
Fasting lipid panel 4
Complete blood count if patient has pre-existing low WBC or history of leukopenia/neutropenia 1

Ongoing Monitoring

Follow-up metabolic monitoring schedule:

BMI: Monthly for 3 months, then quarterly 5
Blood pressure, fasting glucose, and lipids: At 3 months, then yearly 5
Monitor for extrapyramidal symptoms, akathisia, and parkinsonism at each visit 2, 6
Monitor prolactin levels if clinical symptoms suggest hyperprolactinemia 1
Perform CBC monitoring in patients with pre-existing low WBC 1

Safety Considerations and Warnings

Black Box Warnings

Two critical black box warnings apply to Latuda:

Increased mortality in elderly patients with dementia-related psychosis - Latuda is not approved for dementia-related psychosis 1
Suicidal thoughts and behaviors - Antidepressants (including when used for bipolar depression) increase risk of suicidal thoughts in pediatric and young adult patients; close monitoring for clinical worsening and emergence of suicidal thoughts is mandatory 1

Common Adverse Effects

In adults with bipolar depression (incidence ≥5% and twice placebo rate):

Akathisia 1
Extrapyramidal symptoms 1
Somnolence 1

In pediatric patients (10-17 years) with bipolar depression:

Nausea 1
Weight increase 1
Insomnia 1

In schizophrenia patients:

Somnolence 2
Akathisia 2
Nausea 2
Parkinsonism 2

Metabolic Profile

Latuda demonstrates a highly favorable metabolic profile compared to other atypical antipsychotics:

Minimal weight gain 2, 6, 3
No clinically meaningful alterations in glucose 2, 3
No clinically meaningful alterations in lipids 2, 3
Minimal effects on prolactin levels 7, 3

Serious Adverse Events to Monitor

Cerebrovascular adverse reactions:

Increased incidence of stroke and transient ischemic attack in elderly patients with dementia-related psychosis 1

Neuroleptic malignant syndrome:

Manage with immediate discontinuation and close monitoring 1

Tardive dyskinesia:

Discontinue if clinically appropriate 1

Orthostatic hypotension and syncope:

Monitor heart rate and blood pressure, especially in patients with cardiovascular or cerebrovascular disease 1

Leukopenia, neutropenia, and agranulocytosis:

Consider discontinuing if clinically significant WBC decline occurs without other causative factors 1

Hyperprolactinemia:

Prolactin elevations may occur 1, 6

Clinical Efficacy

Latuda demonstrates efficacy across multiple symptom domains:

For schizophrenia:

Effective in treating acute phase symptoms 7
Reduces risk of relapse in long-term treatment 7
Improves positive and negative symptoms 3
Mean PANSS total score reduction of -11.8 at 6 months and -15.3 at 12 months in adolescents and young adults 3

For depressive symptoms in schizophrenia:

Significantly greater decrease in MADRS score (-2.8) compared to placebo (-1.4), with effect size 0.24 8
Among patients with baseline MADRS ≥12, remission achieved in 45.0% of lurasidone-treated patients versus 36.3% on placebo 8

For bipolar depression:

Effective dose range 20-120 mg/day 6
Exhibits both antipsychotic and antidepressant action 6

Common Pitfalls to Avoid

Administration without food:

Failure to take Latuda with at least 350 calories substantially reduces absorption and therapeutic efficacy 1

Combining with contraindicated medications:

Never combine with strong CYP3A4 inhibitors or inducers 1

Inadequate monitoring:

Baseline metabolic monitoring is essential despite favorable metabolic profile 4
Regular monitoring for extrapyramidal symptoms is necessary given higher rates compared to some other atypicals 6

Premature discontinuation:

In long-term studies, 68% of patients completed 12 months of treatment, with only 8.2% discontinuing due to adverse events 3

Use as first-line monotherapy in children and adolescents:

The American Academy of Child and Adolescent Psychiatry recommends combination of psychopharmacological agents plus psychosocial interventions rather than antipsychotic monotherapy 4

Assuming efficacy for all bipolar phases:

Long-term maintenance data remain limited; efficacy should not be assumed for all phases of bipolar disorder 4

What are the recommended dosing, administration with food, monitoring parameters, contraindications, and safety considerations for Latuda (lurasidone) in adults with schizophrenia or bipolar I depression?

Help us tailor your experience