Lurasidone is an atypical antipsychotic medication prescribed for schizophrenia and depressive episodes linked to bipolar I disorder. The dosage is not one-size-fits-all; it is individualized by a healthcare provider based on the condition being treated, the patient’s age, and other health factors.
Standard Dosing by Condition
Schizophrenia
For adults with schizophrenia, the starting dose of lurasidone is 40 milligrams (mg) once daily. A healthcare provider may adjust this amount based on clinical response and tolerance. The effective dose range is between 40 mg and 160 mg daily, with a maximum recommended dose of 160 mg.
Adolescents aged 13 to 17 also begin treatment for schizophrenia with a 40 mg daily dose. Similar to adults, this initial dose does not require a gradual increase (titration). The effective dosage range for this age group is between 40 mg and 80 mg per day, with a maximum recommended dose of 80 mg per day.
Bipolar Depression
For adults with depressive episodes associated with bipolar I disorder, the starting dose is 20 mg once daily. Lurasidone can be used alone (monotherapy) or with mood stabilizers like lithium or valproate. The effective dose range is 20 mg to 120 mg per day. For monotherapy, studies show doses in the 80 mg to 120 mg range did not provide significantly greater efficacy than doses in the 20 mg to 60 mg range.
For pediatric patients aged 10 to 17 with bipolar depression, treatment also begins with a 20 mg dose once daily. The dosage can be adjusted based on the patient’s response. A daily dose between 20 mg and 40 mg is effective for many, while the maximum daily dose for this population should not exceed 80 mg.
Administration and Food Requirements
Lurasidone must be administered with food, specifically a meal of at least 350 calories. This is a strict requirement because taking it with food significantly increases its absorption into the bloodstream, which is necessary for the medication to work properly.
When taken on an empty stomach, the body absorbs much less of the drug, which can render the prescribed dose less effective. The presence of food, particularly its fat and calories, helps transport the medication into circulation. This ensures that the concentration of lurasidone in the body reaches the necessary levels to exert its therapeutic effects.
Patients should take their daily dose during or immediately after a meal that meets the caloric threshold. Forgetting this can lead to inconsistent medication levels in the body, potentially compromising treatment. This administration requirement applies to all dosage strengths and for all patients.
Dosage Adjustments for Medical Conditions
For individuals with certain pre-existing health issues, the standard dosage of lurasidone must be modified to ensure safety and efficacy. The most common reasons for these adjustments are impaired kidney (renal) or liver (hepatic) function. These organs are central to how the body processes and clears medications, and when they are not working at full capacity, drug levels can build up to potentially harmful concentrations.
In cases of moderate to severe renal impairment, a lower dose is recommended. The typical starting dose is reduced to 20 mg per day, and the maximum daily dose should not go above 80 mg. This reduction helps prevent the accumulation of the drug due to the kidneys’ decreased ability to filter it from the blood.
Similarly, adjustments are necessary for patients with moderate to severe hepatic impairment. For those with moderate liver issues, the recommended starting dose is 20 mg daily, with a maximum dose of 80 mg per day. If the liver impairment is severe, the maximum dose is further restricted to 40 mg per day. These modifications are made because a compromised liver cannot metabolize the drug effectively, leading to higher levels in the body.
Handling a Missed Dose
Forgetting to take a dose of medication is a common occurrence. If a dose of lurasidone is missed, the general guidance is to take it as soon as it is remembered. However, this advice comes with an important caveat related to the timing of the next scheduled dose.
If the time you remember is very close to when your next dose is due, the best course of action is to skip the missed dose entirely. You should then resume your regular dosing schedule with the next planned dose. It is important to never take two doses at once or close together to make up for a missed one, as this can increase the risk of side effects.
It is also important not to stop taking lurasidone abruptly without medical supervision. Suddenly discontinuing the medication can lead to withdrawal symptoms or a relapse of the underlying condition. If there is a need to stop treatment, a healthcare provider will create a tapering plan, which involves gradually reducing the dose over time. This process allows the body to adjust slowly and minimizes potential adverse effects.