Lurasidone, commonly known by its brand name Latuda, is an atypical antipsychotic medication prescribed to manage certain mental health conditions. It has received approval from the U.S. Food and Drug Administration (FDA) for treating schizophrenia in adults and adolescents aged 13 to 17 years. The medication also addresses depressive episodes associated with bipolar I disorder in adults, both as a standalone treatment and when used with other medications, as well as in pediatric patients aged 10 to 17 years. Dosing for lurasidone is highly individualized, with a healthcare professional determining the appropriate amount based on the specific condition, the patient’s age, and other relevant medical factors.
Recommended Dosages for Approved Conditions
Dosing for lurasidone varies depending on the condition being treated and the patient’s age. For adults diagnosed with schizophrenia, the usual starting dose is 40 milligrams (mg) once daily, with a recommended daily dose range between 40 mg and 160 mg. While initial dose titration is not always necessary, many patients achieve an optimal response within the 40 mg to 80 mg daily range. The maximum recommended daily dose for adult schizophrenia is 160 mg.
Adolescents aged 13 to 17 years who are being treated for schizophrenia begin with a 40 mg dose once daily. The maximum recommended daily dose for this age group is 80 mg. Some healthcare providers may initiate treatment at a lower dose, such as 20 mg, to assess tolerability before increasing to 40 mg, especially in younger adolescents or those with smaller body weight.
For adults experiencing major depressive episodes associated with bipolar I disorder, lurasidone can be used as monotherapy, beginning with a 20 mg dose once daily. The maximum recommended dose for monotherapy is 120 mg per day. Studies indicate that a higher dose range (80 mg to 120 mg per day) generally does not provide additional benefits compared to a lower range (20 mg to 60 mg per day) when used alone.
When lurasidone is used as adjunctive therapy for bipolar depression in adults, alongside lithium or valproate, the starting dose is also 20 mg once daily. The maximum recommended dose for this adjunctive use is 120 mg per day. There is no need to adjust the doses of lithium or valproate when co-administering them with lurasidone.
Pediatric patients aged 10 to 17 years receiving treatment for bipolar depression start with a 20 mg dose once daily. The maximum recommended daily dose for this pediatric population is 80 mg. Doses can be gradually increased after about one week, based on the patient’s response and how well they tolerate the medication.
Administration and Timing
Lurasidone must be taken once daily with food. This food requirement is quite specific, necessitating a meal or snack containing at least 350 calories. Taking the medication on an empty stomach significantly decreases the amount of lurasidone the body absorbs, which can reduce its effectiveness.
The presence of food substantially increases the medication’s bioavailability. Maintaining consistency in the daily timing of the dose can help keep the medication’s levels stable in the bloodstream. While some patients find taking it with an evening meal helps with certain side effects like restlessness, others may prefer morning dosing.
If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped entirely. It is important never to take two doses at once to compensate for a missed one.
Dose Adjustments for Medical Conditions and Drug Interactions
Patients with certain medical conditions, particularly those affecting kidney or liver function, may require adjustments to their lurasidone dosage. For individuals with moderate to severe kidney impairment, the recommended starting dose is typically 20 mg per day. The maximum daily dose for these patients should not exceed 80 mg.
For moderate liver impairment, the recommended starting dose is 20 mg per day, with a maximum daily dose of 80 mg. For severe liver impairment, the starting dose remains 20 mg per day, but the maximum daily dose is further reduced to 40 mg.
Lurasidone is primarily broken down in the body by an enzyme system known as cytochrome P450 3A4 (CYP3A4). Many medications can affect this enzyme, leading to significant drug interactions. Co-administration of lurasidone with strong CYP3A4 inhibitors, such as ketoconazole, clarithromycin, or ritonavir, is not recommended because these drugs can dramatically increase lurasidone levels in the body, raising the risk of side effects. Likewise, strong CYP3A4 inducers, including rifampin, phenytoin, or St. John’s Wort, are also not recommended. These medications can significantly decrease lurasidone levels, potentially making it less effective.
If a patient is taking a moderate CYP3A4 inhibitor, like diltiazem or erythromycin, the lurasidone dose should be reduced to half of the original level, with a recommended starting dose of 20 mg per day and a maximum of 80 mg per day. Patients should also avoid grapefruit and grapefruit juice, as they can inhibit CYP3A4 and affect lurasidone concentrations. It is always important to inform the prescribing doctor about all other medications, including over-the-counter drugs and herbal supplements, to prevent potential interactions.
Stopping Lurasidone Treatment
Discontinuing lurasidone treatment should never be done abruptly without guidance from a healthcare professional. Suddenly stopping the medication can lead to a range of uncomfortable withdrawal-like symptoms, and it may also cause a relapse of the underlying condition being treated.
Symptoms that can emerge from sudden discontinuation include nausea, vomiting, diarrhea, dizziness, and restlessness. Patients may also experience anxiety, agitation, difficulty sleeping, muscle aches, or involuntary muscle movements. A return or worsening of the original symptoms of schizophrenia or bipolar depression is also a possibility.
To minimize these effects, a healthcare provider will typically recommend a gradual reduction in dosage, known as tapering. This process involves slowly lowering the dose over a period of time, which can range from weeks to several months, allowing the body to adjust progressively. Any decision to stop or alter the lurasidone dosage must be made in close consultation with the prescribing doctor.