Lurasidone or Latuda® is a second-generation antipsychotic, manufactured by Sunovion and introduced in the US in 2010 for the acute treatment of schizophrenia.
1. Acute treatment of schizophrenia (2010)
2. Bipolar I depression – monotherapy
3. Bipolar I depression – as an adjunct to lithium or valproate
Note: no mania study has been done; I assume that this must be because many antimanic agents were already available and bipolar depression was where the “unmet need” was.
Starting Dose: 40 mg per day
Recommended Dose: 40 mg to 160 mg per day
Starting Dose: 20 mg per day
Recommended Dose: 20 mg to 120 mg per day
1. Lurasidone should be taken with food (at least 350 calories).
2. Recommended starting and maximum dose is 20 mg/day and 40 mg/day respectively for patients with moderate and severe renal impairment.
3. The maximum recommended dose is 80 mg per day and 40 mg per day in moderate and severe hepatic impairment respectively.
4. Concomitant Use of a Moderate CYP3A4 inhibitor (e.g., diltiazem): Lurasidone dose should be reduced to half of the original dose level. Recommended starting dose is 20 mg per day. Maximum recommended dose is 80 mg per day.
5. Concomitant Use of a Moderate CYP3A4 Inducer: It may be necessary to increase the dose of Lurasidone.
6. Geriatric use: Do not use lurasidone in dementia-related psychosis. Also, it is unknown whether dose adjustment is necessary for elderly patients.
Dosage forms and strengths
Tablets: 20 mg, 40 mg, 60 mg, 80 mg, 120 mg
Please refer to Prescribing Information (see link below) for a complete discussion of dosage, administration, warnings and precautions, contraindications, etc.
I wish we would stop calling them “atypical” antipsychotics, for reasons that I have argued in a letter to the editor (Mago, R, Kipnis, D: Atypicals are really typicals now. Psychiatry 2006;3:20-21.)
What is the half-life of lurasidone and why does that matter?
Since the half-life of lurasidone is 18 hours, it can be prescribed in once-a-day dosing, which is more convenient and hence better for adherence.
Aripiprazole has a half-life of 72 hours, which has pros and cons. If a person develops an adverse effect on aripiprazole, it takes a longer time for the adverse effect to subside, even if the aripiprazole is stopped. On the other hand, I just had a patient who had akathisia on lurasidone. We stopped the lurasidone and the akathisia was markedly better within a day.
Lurasidone must be taken with food
An important thing to remember is that the maximum concentration of lurasidone is reduced by half (i.e., a lot) if it is not taken with food.
The patient may ask: can I take it with a small snack? The answer is that it depends on what your definition of a “small snack” is! The manufacturer recommends that lurasidone be taken with at least 350 calories of food. Whether that food is high fat or low fat does not matter.
What dose of lurasidone should I prescribe?
The standard recommendation is to start at 40 mg, once a day. However, patients with bipolar depression may be more sensitive to adverse effects than patients with schizophrenia. Therefore, it may be wise to start with 20 mg/day in patients with bipolar depression. The dose can be gradually increased to a maximum of 160 mg/day. Note: when lurasidone was initially introduced, the recommended maximum dose was 80 mg/day; this was later changed to 160 mg/day.
Lurasidone is available in a range of pill sizes: 20 mg, 40 mg, 60 mg, 80 mg, and 120 mg. However, if you start with a 20 mg pill, keep in mind that you can only give the patient a prescription for 30 pills. There are “quantity limitations” on the number of pills the person can get per month. This makes it a bit inconvenient to increase to 40 mg/day after a few days. Isn’t it better to prescribe 40 mg pills, but ask the patient to start with half pill per day for a certain number of days? Then, if there are no significant side effects, increase to a full pill per day. Now, the pills are not scored, but they can be cut with a pill cutter and the division of the pill doesn’t have to be exact.
Lurasidone (Latuda®): Pharmacological Effects
Lurasidone (Latuda®): Efficacy
Lurasidone (Latuda®): Drug Interactions
Lurasidone (Latuda®): Adverse Effects
Lurasidone Prescribing Information
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I would like to use more Latuda [lurasidone], but patients often balk at the high copay. Any thoughts? Is a generic coming anytime soon?
Rajnish Mago, MD says
Thanks, Jack, for your question.
1. For lurasidone and for other medications, you can find discount cards at http://www.needymeds.org. For Latuda, as of May 2020, needymeds.org links to a discount card at https://www.latuda.com/bpd/latuda-savings-and-support.html#signup. Patients can go to that link, fill out their information, and get a discount card. As long as the prescription is not paid in part of full by any state or federally funded health care program (Medicare, Medicaid, VA, DOD, TRICARE, etc.), the card provides up to $400 off each 30-day prescription.
2. As of May 2020, generics for lurasidone have already been approved by the FDA. They are expected to become available in pharmacies as soon as the generic manufacturer can get them there.
Latuda must not be cut in halves
Rajnish Mago, MD says
The manufacturer says so, but are you aware of any scientific reason to not split Latuda pills? Thanks!
The medicine may not be evenly distributed.
Seth Crouser says
The manufacturer says they must not be split in half now, however their former prescribing information did not include this limitation. There was a paper written in 2017 that concluded the significant cost savings that pill cutting could provide if implemented in hospitals focusing specifically on Latuda and Abilify. That paper noted that neither drug manufacturers specified that the pills should not be split, referencing the prescribing instructions published by Sunovion in 2013. Interestingly then, sometime after this paper was published, Sunovion began warning that Latuda should not be split, but I can find no valid reason why they have changed their recommendations, aside from corporate greed.