Lurasidone

LATUDA

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What it isD2, 5-HT2A, and 5-HT7 antagonist with 5-HT1A partial agonism; schizophrenia and bipolar depression.

Why this oneIts low metabolic burden distinguishes it from quetiapine and olanzapine in bipolar depression.

What limits itIt must be taken with at least 350 calories or absorption halves. Akathisia is common; CYP3A4-dependent.

FDA-approved for

schizophrenia (2010)
bipolar depression (2013)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Increased mortality in elderly patients with dementia-related psychosis; suicidal thoughts and behaviors in pediatric/young adults. Not approved for dementia-related psychosis.

FDA dosing	Population	Start	Target	Max
Schizophrenia	Adults	40 mg QD	40–160 mg/day	160 mg/day
Schizophrenia	Adolescents 13–17 yr	40 mg QD	40–80 mg/day	80 mg/day
Bipolar I depression (monotherapy or adjunct to lithium/valproate)	Adults	20 mg QD	20–120 mg/day	120 mg/day
Bipolar I depression (monotherapy)	Pediatric 10–17 yr	20 mg QD	20–80 mg/day	80 mg/day

Titration Initial titration not required; pediatric bipolar dose may be increased after 1 week per clinical response.

Renal Moderate or severe (CrCl <50 mL/min): start 20 mg/day, max 80 mg/day.

Hepatic Moderate (Child-Pugh 7–9): start 20 mg/day, max 80 mg/day. Severe (10–15): start 20 mg/day, max 40 mg/day.

Instructions

Take with food (at least 350 calories).
Avoid grapefruit and grapefruit juice.

Contraindications

Concomitant strong CYP3A4 inhibitor (e.g., ketoconazole)
Concomitant strong CYP3A4 inducer (e.g., rifampin)

Cautions

Cerebrovascular reactions (stroke, TIA) in elderly with dementia
Neuroleptic malignant syndrome
Tardive dyskinesia
Metabolic changes (hyperglycemia/diabetes, dyslipidemia, weight gain)
Hyperprolactinemia
Leukopenia, neutropenia, agranulocytosis
Orthostatic hypotension and syncope
Seizures
Activation of mania/hypomania

Adverse reactions

Somnolence
Akathisia
Extrapyramidal symptoms
Nausea
Vomiting
Dyspepsia

Pregnancy Limited human data; third-trimester exposure risks neonatal EPS/withdrawal.

Lactation Not studied in human milk; present in rat milk.

⚠ BOXED WARNING

Increased mortality in elderly patients with dementia-related psychosis

Cost, est. cash$5–$150/month

Generic entry2019

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability1 / 4

Sedation liability1 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryB

Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.

Mechanism of action: Lurasidone ballicule

Lurasidone ballicule: receptor binding, kinetics and half-life diagram

Open Lurasidone in the interactive console ↗

Memory aids: mascots and interaction avatars

Lurasidone LATUDA mascot mnemonic cartoon — **“Lured (to the) Latitude”**
Antipsychotics are represented with spooky mascots

CYP3A4 substrate

Open Lurasidone in the interactive console ↗