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Lurasidone

Brands and Forms

  • Latuda
    • tablet: 40mg, 80mg

Uses of Lurasidone

Lurasidone is indicated in the treatment of Schizophrenia and Bipolar Disorder, and may also be used for treating other Psychotic Disorders, Depressive Disorders, PTSD, OCD, and Tic Disorder.

Lurasidone can also be used in the management of behavioral disturbances, such as agitation and impulsivity, that can occur in various conditions like Impulse-Control Disorders, Disruptive Behavior Disorders, and Borderline Personality Disorder.

How Lurasidone Works

Lurasidone is an Atypical Antipsychotic. Its mechanism of action is not completely understood, but it is known to be a partial agonist at serotonin 5-HT-1A receptors, and an antagonist at dopamine D-2 and serotonin 5-HT-2A receptors.

Cautions when Using Lurasidone

In elderly individuals with Dementia, use of Antipsychotics has been associated with increased rates of sudden death. It is unclear whether the antipsychotic use is a cause, or simply a marker, of deteriorating health in these individuals.

Individuals with Parkinson disease or Lewy-Body Dementia may have increased sensitivity to Lurasidone, which may manifest as confusion, obtundation, severe extrapyramidal symptoms, and neuroleptic malignant syndrome.

Dosing of Lurasidone

Lurasidone should be taken with food (at least 350 calories).

Lurasidone is started at 40mg once daily. It is usually taken at bedtime, given that it can cause sedation. In some cases it may cause insomnia or mild restlessness, and could be taken in the morning.

In many cases, the starting dose of 40mg daily will be sufficient. The next dose increment is 80mg one daily, which should be sufficient for a majority of patients. Doses of 120mg or 160mg once daily may be considered in certain patients based on individualized clinical judgement.

When wanting to stop this medication, it is best to decreased the dose gradually over a period of 2 weeks or more.

Onset of action

Symptoms of Mania and Psychosis can improve within 1 week of use, but full therapeutic effect may take several weeks. If there is no significant effect after 4-6 weeks, including a couple of weeks at doses above 80mg/day, then it may not work at all.

For other conditions, 4-6 weeks may be needed to see a therapeutic effect.

Kidney impairment

Dose adjustment is recommended in moderate and severe renal impairment patients. The dose in these cases should not exceed 40 mg/day.

Liver impairment

Dose adjustment is recommended in moderate and severe livier impairment patients. The dose in these cases should not exceed 40 mg/day

Side-effects of Lurasidone

Below is a list of most of the reported side-effects of Lurasidone. Most of these side-effects occur in only a minority of individuals, and many also resolve with time while the medication is continued.

Cardiovascular: tachycardia; hypertension; orthostatic hypotension; syncope; 1st degree AV block (rare); angina pectoris (rare); bradycardia (rare).

Central Nervous System: hypersomnia; hypersomnolence; sedation/somnolence; extrapyramidal symptoms including akathisia; cerebrovascular accident; dysarthria, syncope; seizure (rare).

Dermatologic: rash; pruritus; angioedema (rare).

Endocrine/Metabolic: amenorrhea; dysmenorrhea; breast enlargement; breast pain; galactorrhea.

Gastrointestinal: decreased appetite; nausea; vomiting; dyspepsia; abdominal pain; gastritis; diarrhea; dysphagia; salivary hypersecretion.

Genitourinary: erectile dysfunction.

Hematologic: anemia, leukopenia and neutropenia (rare).

Musculoskeletal: back pain; neuroleptic malignant syndrome (rare).

Psychiatric: agitation; anxiety; abnormal dreams; panic attack; sleep disorder; restlessness; suicidal behavior (rare).

Renal: dysuria; renal failure (rare).

Common side-effects of Lurasidone

Nausea, somnolence/sedation, and extrapyramidal symptoms including akathisia.

Rare but serious side-effects of note of Lurasidone

  • increased risk of sudden death in elderly individuals with Dementia.
  • neuroleptic malignant syndrome
  • cardiac arrhythmias
  • seizures
  • hypersensitivity reaction
  • anemia, leukopenia or neutropenia
  • renal failure
  • suicidal behaviours

Lurasidone overdose

No data available.

Lurasidone and pregnancy

Category B: animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women; or, animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.

Neonates exposed to antipsychotic drugs during the third trimester of pregnancy are at risk of extrapyramidal and/or withdrawal symptoms following delivery.

Lurasidone, weight gain and metabolic syndrome

Lurasidone is considered to be one of the few atypical antipsychotics that has not been shown to have a significant risk of causing weight gain or metabolic side-effects (see here for further information on this topic).

Medical Monitoring for Lurasidone

Monitoring for weight gain and a metabolic syndrome requires the following measures to be taken prior to starting the medication, then monthly for the first 3 months of use, and then every 3 months:

  • Body Mass Index (BMI)
  • waistline circumference at umbilicus
  • blood pressure
  • fasting blood glucose
  • fasting blood lipids and cholesterol

To monitor for elevated prolactin, prolactin levels should be measured prior to starting the medication, and then one month after starting and after every dose increase.

Drug Interactions with Lurasidone

  • Lurasidone may enhance the effects of some antihypertensives.
  • Grapefruit juice can increase Lurasidone blood levels. Avoid a dose of more than 40mg daily when consuming grapefruit juice.
  • Lurasidone blood concentrations can be reduced by carbamazepine, dexamethasone, phenobarbital, phenytoin, rifabutin, rifampin, and rifapentine.
  • Lurasidone blood concentrations can be increased by aprepitant, diltiazem, erythromycin, fluconazole, fosamprenavir, atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole, and verapamil. In these cases, the dose of Lurasidone should not exceed 40mg daily.