Lurasidone (Latuda)

Primer

Lurasidone (Trade name: Latuda) is an antipsychotic in the atypical antipsychotic class commonly used in the treatment of schizophrenia and bipolar depression.

Pharmacokinetics

Pharmacokinetics of Lurasidone

Absorption
Distribution
Metabolism
Elimination
Half-life

Lurasidone: Cytochrome P450 Metabolism

Substrate of (Metabolized by)
Induces
Inhibits

Pharmacodynamics

Mechanism of Action

  • Lurasidone has a combination of dopamine (D2) and serotonin (5-HT2A) antagonism.[1]

Toxicity

Indications

Dosing

Dosing for Lurasidone

Starting The recommended dose is 40-80 mg given once daily, with no titration needed.
Lurasidone must be taken with a meal/food with at least 350 calories (or else its absorption is reduced by 50%).[2]
Titration No titration needed, but can be increased.
Maximum 80mg PO daily (studies have gone up to 120mg with no difference in improvement)
Taper Tapering/Switching Antipsychotics
  • In one monotherapy study, a higher dose range (80 mg to 120 mg per day) did not provide any additional efficacy compared to the lower dose range (20 to 60 mg per day).[3]

Formulations

  • Lurasidone comes in an oral tablet formulation

Monitoring

Contraindications

Absolute

Relative

Drug-Drug Interactions

Side Effects

Adverse Events

Clinical Pearls

  • In patients with bipolar depression, responses to high or low lurasidone doses are linearly related to baseline CRP levels, indicating the role of CRP as a possible biomarker for treatment response.[4]
  • Lurasidone is essentially an “improved” ziprasidone, in that there is no QTc prolongation risk, and also you can do once daily dosing (unlike BID dosing with ziprasidone).

Special Populations

Geriatric

Pediatric

Obstetric and Fetal

Medically Ill

Resources

References

1) Kane, J. M. (2011). Lurasidone: a clinical overview. The Journal of clinical psychiatry, 72, 24-28.
2) Preskorn, S., Ereshefsky, L., Chiu, Y. Y., Poola, N., & Loebel, A. (2013). Effect of food on the pharmacokinetics of lurasidone: Results of two randomized, open‐label, crossover studies. Human Psychopharmacology: Clinical and Experimental, 28(5), 495-505.
3) Citrome, L. (2011). Lurasidone for schizophrenia: a review of the efficacy and safety profile for this newly approved second‐generation antipsychotic. International journal of clinical practice, 65(2), 189-210.
4) Raison, C. L., Pikalov, A., Siu, C., Tsai, J., Koblan, K., & Loebel, A. (2018). C-reactive protein and response to lurasidone in patients with bipolar depression. Brain, behavior, and immunity, 73, 717-724.