Lurasidone (Latuda)

Second generation antipsychotic (dopamine, serotonin receptor antagonist (D2, 5-HT2))

  • Bipolar Depression (10+)
  • May not work in mania, but treats mixed states
  • Schizophrenia (13+)
  • Bipolar Mixed
  • Bipolar Cognition

Features

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Handout

Dosing

20-120 mg/d (for depression, avg 40-60 mg/d). Start 20mg 1/2 qd x4days, 1 qd x4days then 2 qd (take with at least 350cal meal). Starting slow reduces akathisia.

Absorption drops 30-70% if taken on an empty stomach.

INTERACTIONS: Metabolized by 3A4. Raise 3-5x with carbamazepine. Lower 2x with nefazodone and grapefruit juice. May need to lower a little with non-pram SSRIs (fluoxetine, fluvoxamine, paroxetine, sertraline ≥ 150 mg/day).

Management

Does not treat mania but helps mixed states. Improves cognition in bipolar.

TOLERABILITY: Weight gain, sedation, akathisia, EPS (dystonia, stiffness), anticholinergic.

RISKS: Tardive dyskinesia (25% over 10 years, higher in elderly), metabolic, prolactinemia (can lead to breast cancer, osteopenia, sexual dysfunction), orthostasis (falls), QTc prolongation, temperature imbalance in elderly, NMS (muscle rigidity, fever, tachycardia).

Side Effect Management

EMR Text

Bipolar depression

Lurasidone use based on FDA approval in bipolar depression.

Antipsychotic side effects, including metabolic, prolactinemia, and TD, reviewed with patient.

Depression with mixed features

Lurasidone use based on large, controlled trials in major depression with mixed features (Suppes T et al,Am J Psychiatry. 2016;173(4):400-407)

Antipsychotic side effects, including metabolic, prolactinemia, and TD, reviewed with patient.

Schizophrenia

Lurasidone use based on FDA approval in schizophrenia.

Antipsychotic side effects, including metabolic, prolactinemia, and TD, reviewed with patient.

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