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Latuda
lurasidone
Black Box Warnings .
Dementia-Related Psychosis
not approved for dementia-related psychosis; incr. mortality risk in elderly dementia pts on conventional or atypical antipsychotics; most deaths due to cardiovascular or infectious events; extent to which incr. mortality attributed to antipsychotic vs. some pt characteristic(s) not clear
Suicidality
incr. suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders; weigh risk vs. benefit; in short-term studies of antidepressants vs. placebo, suicidality risk not incr. in pts >24 yo, and risk decr. in pts 65 yo and older; depression and certain other psychiatric disorders themselves assoc. w/ incr. suicide risk; observe all pts for clinical worsening, suicidality, or unusual behavior changes; advise families and caregivers of need for close observation and communication w/ prescriber
Adult Dosing .
Dosage forms: TAB: 20 mg, 40 mg, 60 mg, 80 mg, 120 mg
schizophrenia
- [40-160 mg PO qd]
- Start: 40 mg PO qd; Max: 160 mg/day; Info: give w/ food containing >350 calories
bipolar I disorder, acute depressive
- [20-120 mg PO qd]
- Start: 20 mg PO qd; Max: 120 mg/day; Info: for monotherapy or valproate or lithium adjunct; doses >80 mg/day rarely more effective as monotherapy; give w/ food containing >350 calories
renal dosing
- [see below]
- CrCl <50: start 20 mg qd, max 80 mg/day
- HD/PD: not defined
hepatic dosing
- [adjust dose amount]
- Child-Pugh Class B: start 20 mg qd, max 80 mg/day; Class-Pugh Class C: start 20 mg qd, max 40 mg/day
Peds Dosing .
- Dosage forms: TAB: 20 mg, 40 mg, 60 mg, 80 mg
schizophrenia
- [13-17 yo]
- Dose: 40-80 mg PO qd; Start: 40 mg PO qd; Max: 80 mg/day; Info: give w/ food containing >350 calories
bipolar I disorder, acute depressive
- [10-17 yo]
- Dose: 20-80 mg PO qd; Start: 20 mg PO qd x1wk; Max: 80 mg/day; Info: for monotherapy; give w/ food containing >350 calories
renal dosing
- [see below]
- CrCl <50: start 20 mg qd, max 80 mg/day
- HD/PD: not defined
hepatic dosing
- [adjust dose amount]
- Child-Pugh Class B: start 20 mg qd, max 80 mg/day; Class-Pugh Class C: start 20 mg qd, max 40 mg/day
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- caution: elderly pts
- caution: psychosis, dementia-associated
- caution: dementia w/ Lewy bodies
- caution: Parkinson dz
- caution: diabetes mellitus
- caution: diabetes mellitus risk
- caution: leukopenia
- caution: leukopenia hx, drug-induced
- caution: neutropenia
- caution: neutropenia hx, drug-induced
- caution: hepatic impairment, Child-Pugh Class B-C
- caution: CrCl <50
- caution: cardiovascular dz
- caution: cerebrovascular dz
- caution: electrolyte abnormalities
- caution: long QT syndrome, congenital
- caution: QT prolongation
- caution: QT prolongation family hx
- caution: torsades de pointes hx
- caution: ventricular arrhythmia
- caution: bradycardia
- caution: MI, recent
- caution: CHF
- caution: hypotension
- caution: hypovolemia
- caution: dehydration
- caution: environmental temperature, high
- caution: seizure hx
- caution: CNS depressant use, concurrent
- caution: alcohol use, concurrent
- caution: suicide risk
- caution: aspiration pneumonia risk
- caution: neuroleptic malignant syndrome hx
Drug Interactions .
Overview
lurasidone
atypical antipsychotic
- CYP3A4 substrate
- CYP3A4 inhibitor, weak
- CNS depression
- dopamine antagonist
- extrapyramidal effects
- hyperglycemic effects
- hyperprolactinemic effects
- hyperthermia
- hypotensive effects
- lowers seizure threshold
- prolongs QT interval (conditional)
Contraindicated
- adagrasib
- apalutamide
- atazanavir
- butalbital
- carbamazepine
- ceritinib
- chloramphenicol
- cisapride
- clarithromycin
- cobicistat
- darunavir
- eliglustat
- encorafenib
- enzalutamide
- fosamprenavir
- fosphenytoin
- idelalisib
- itraconazole
- ivosidenib
- ketoconazole
- lefamulin
- levoketoconazole
- lonafarnib
- lopinavir/ritonavir
- lumacaftor/ivacaftor
- mifepristone
- mitotane
- nefazodone
- nelfinavir
- pentobarbital
- phenobarbital
- phenytoin
- pimozide
- posaconazole
- primidone
- ribociclib
- rifabutin
- rifampin
- ritonavir
- St. John's wort
- thioridazine
- tipranavir
- tucatinib
- voriconazole
Avoid/Use Alternative
- aldesleukin
- alprazolam
- amifampridine
- apomorphine
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- arsenic trioxide
- asenapine
- bedaquiline
- benztropine
- brexpiprazole
- bromocriptine
- cabergoline
- cariprazine
- clonidine
- codeine
- colchicine
- crizotinib
- domperidone
- doxylamine
- dronedarone
- ephedra
- ethanol
- fexinidazole
- grapefruit
- hydrocodone
- hydroxychloroquine
- iloperidone
- isocarboxazid
- kava
- kratom
- lofexidine
- lumateperone
- lurasidone
- meperidine
- metaxalone
- methadone
- metoclopramide
- midazolam
- mobocertinib
- netupitant
- olanzapine
- oxybate
- oxycodone
- paliperidone
- phenelzine
- pralsetinib
- promethazine
- propafenone
- quetiapine
- quizartinib
- rasagiline
- risperidone
- ropeginterferon alfa-2b
- safinamide
- selegiline
- selegiline transdermal
- simvastatin
- sotalol
- thalidomide
- toremifene
- tranylcypromine
- trimethobenzamide
- triptorelin
- vandetanib
- ziprasidone
- zuranolone
Monitor/Modify Tx
- abemaciclib
- acalabrutinib
- acarbose
- acebutolol
- alfentanil
- alfuzosin
- aliskiren
- alogliptin
- amantadine
- amifostine
- amiloride
- amiodarone
- amitriptyline
- amlodipine
- amoxapine
- anagrelide
- apraclonidine ophthalmic
- aprepitant
- aprocitentan
- artemether/lumefantrine
- articaine
- asciminib
- atenolol
- atorvastatin
- avacopan
- avanafil
- avapritinib
- azilsartan medoxomil
- azithromycin
- baclofen intrathecal
- belumosudil
- benazepril
- berberine
- berotralstat
- betaxolol
- betaxolol ophthalmic
- bethanechol
- bexagliflozin
- bicalutamide
- bisoprolol
- bortezomib
- bosentan
- brigatinib
- brimonidine ophthalmic
- brimonidine topical
- bumetanide
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- bupropion
- butorphanol
- cabozantinib
- canagliflozin
- candesartan cilexetil
- cannabis
- capivasertib
- captopril
- carteolol ophthalmic
- carvedilol
- cenobamate
- chlordiazepoxide
- chloroprocaine
- chloroquine
- chlorothiazide
- chlorpromazine
- chlorthalidone
- chlorzoxazone
- cilostazol
- cimetidine
- ciprofloxacin
- citalopram
- clevidipine
- clobazam
- clofarabine
- clofazimine
- clomipramine
- clonazepam
- clorazepate
- clotrimazole oropharyngeal
- clozapine
- coenzyme Q-10
- colesevelam
- conivaptan
- cranberry
- cyclosporine
- dabrafenib
- danazol
- dapagliflozin
- daridorexant
- degarelix
- denileukin diftitox
- desflurane
- desipramine
- dexmedetomidine
- dexmedetomidine injection
- diazepam
- dihydrocodeine
- diltiazem
- dinutuximab
- diosmin
- dipyridamole
- disopyramide
- docetaxel
- dofetilide
- donepezil
- doxazosin
- doxepin
- dronabinol
- droperidol
- dulaglutide
- duloxetine
- duvelisib
- efavirenz
- empagliflozin
- enalapril
- enalaprilat
- entacapone
- entrectinib
- epirubicin
- eplerenone
- epoprostenol
- eribulin
- ertugliflozin
- erythromycin
- esketamine
- esmolol
- estazolam
- eszopiclone
- ethacrynic acid
- ethanol (in some formulations)
- ethinyl estradiol (contraceptive)
- etomidate
- etravirine
- everolimus
- exenatide
- fedratinib
- felodipine
- fenoldopam
- fentanyl
- ferumoxytol
- finerenone
- flaxseed
- flecainide
- flibanserin
- fluconazole
- fluorouracil
- fluphenazine
- flurazepam
- fluvoxamine
- fosaprepitant
- fosinopril
- foslevodopa
- fostamatinib
- furosemide
- gabapentin
- gabapentin enacarbil
- garlic
- gepirone
- gepotidacin
- gilteritinib
- ginkgo
- givinostat
- givosiran
- glasdegib
- glecaprevir
- glimepiride
- glipizide
- glyburide
- goldenseal
- goserelin
- grazoprevir
- guanfacine
- haloperidol
- histrelin
- hydralazine
- hydrochlorothiazide
- hydromorphone
- hydroxyzine
- ibrutinib
- ibutilide
- ifosfamide
- iloprost
- iloprost inhaled
- imatinib
- imipramine
- indapamide
- inotuzumab ozogamicin
- insulin
- iohexol
- iopamidol
- irbesartan
- iron sucrose
- isavuconazonium
- isoflurane
- isoniazid
- isosorbide dinitrate
- isosorbide mononitrate
- isradipine
- istradefylline
- ivabradine
- ivacaftor
- ixabepilone
- ketamine
- labetalol
- landiolol
- lapatinib
- larotrectinib
- lazertinib
- lemborexant
- lenacapavir
- letermovir
- leuprolide
- levobunolol ophthalmic
- levodopa
- levofloxacin
- levorphanol
- lidocaine
- linagliptin
- liraglutide
- lisinopril
- lithium
- lixisenatide
- lomitapide
- lorazepam
- lorlatinib
- losartan
- lovastatin
- loxapine
- lubiprostone
- lurbinectedin
- macimorelin
- magnesium sulfate
- maraviroc
- maribavir
- mavacamten
- mavorixafor
- mepivacaine
- metformin
- methohexital
- methyldopa
- methylene blue injection
- metolazone
- metoprolol
- miglitol
- milrinone
- minoxidil
- mirtazapine
- mitapivat
- modafinil
- moexipril
- molindone
- morphine
- moxifloxacin
- nadolol
- nafcillin
- nalbuphine
- nateglinide
- nattokinase
- naxitamab
- nebivolol
- nelarabine
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- nirogacestat
- nisoldipine
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- nortriptyline
- oliceridine
- olmesartan medoxomil
- ondansetron
- opicapone
- opium
- osilodrostat
- osimertinib
- oxazepam
- oxybutynin
- oxymorphone
- pacritinib
- palbociclib
- palonosetron
- palopegteriparatide
- panobinostat
- pasireotide
- pazopanib
- pemigatinib
- pentamidine
- pentazocine
- peppermint
- perindopril
- perphenazine
- pexidartinib
- phenoxybenzamine
- phentolamine
- pibrentasvir
- pindolol
- pioglitazone
- pirtobrutinib
- pramipexole
- pramlintide
- prazosin
- pregabalin
- procainamide
- procarbazine
- prochlorperazine
- propofol
- propranolol
- protriptyline
- quazepam
- quercetin
- quinapril
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quinine
- ramipril
- ranolazine
- red yeast rice
- remdesivir
- remifentanil
- remimazolam
- repaglinide
- repotrectinib
- resveratrol
- revumenib
- rifapentine
- riociguat
- ritlecitinib
- romidepsin
- ropinirole
- ropivacaine
- rosiglitazone
- rotigotine transdermal
- rucaparib
- sacubitril
- saxagliptin
- selpercatinib
- selumetinib
- semaglutide
- sevoflurane
- sildenafil
- silodosin
- sirolimus
- sirolimus albumin-bound
- sitagliptin
- sodium ferric gluconate complex
- sotagliflozin
- sotorasib
- sparsentan
- spironolactone
- stiripentol
- sufentanil
- suvorexant
- tacrolimus
- tadalafil
- tagraxofusp
- tamsulosin
- tapentadol
- taurine
- telavancin
- telmisartan
- temazepam
- temsirolimus
- terazosin
- tetrabenazine
- thiothixene
- ticagrelor
- timolol
- timolol ophthalmic
- tirzepatide
- tizanidine
- tolcapone
- tolvaptan
- torsemide
- tramadol
- trandolapril
- trazodone
- treosulfan
- treprostinil
- triamterene
- triazolam
- triclabendazole
- trifluoperazine
- trifluridine
- trimipramine
- trofinetide
- ubrogepant
- valsartan
- vardenafil
- vemurafenib
- venetoclax
- verapamil
- viloxazine
- vinblastine
- vincristine
- vinorelbine
- vonoprazan
- vosoritide
- voxelotor
- warfarin
- xanomeline
- yohimbe
- zaleplon
- zanubrutinib
- ziconotide
- zileuton
- zolpidem
Caution Advised
- 5-HTP
- acetazolamide
- aclidinium inhaled
- allopurinol
- almotriptan
- armodafinil
- atropine
- baclofen
- belladonna alkaloids
- belzutifan
- bexarotene
- botulinum toxin
- brivaracetam
- brompheniramine
- buspirone
- busulfan
- cannabidiol
- carbinoxamine
- carisoprodol
- cetirizine
- chamomile, German
- chasteberry
- chlophedianol
- chlorambucil
- chlorpheniramine
- clemastine
- clidinium
- cobimetinib
- cyclobenzaprine
- cyclophosphamide
- cyproheptadine
- danshen
- dantrolene
- darifenacin
- darolutamide
- deferasirox
- desvenlafaxine
- deutetrabenazine
- dexamethasone
- dexbrompheniramine
- dexchlorpheniramine
- dichlorphenamide
- dicloxacillin
- dicyclomine
- difelikefalin
- difenoxin
- dihydroergotamine
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- doxepin topical
- echinacea
- elafibranor
- elagolix
- eletriptan
- enasidenib
- ergotamine
- escitalopram
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fenfluramine
- fesoterodine
- flavoxate
- fluoxetine
- frovatriptan
- galantamine
- ganaxolone
- ginseng, Asian
- glofitamab
- glycerol phenylbutyrate
- glycopyrrolate
- glycopyrrolate inhaled
- glycopyrronium topical
- griseofulvin
- homatropine
- hyoscyamine
- ipratropium inhaled
- lacosamide
- lamotrigine
- lasmiditan
- levetiracetam
- levocetirizine
- levomilnacipran
- linvoseltamab
- magnesium citrate
- meclizine
- melatonin
- meprobamate
- meropenem
- methocarbamol
- methscopolamine
- methsuximide
- methylergonovine
- metyrapone
- metyrosine
- milnacipran
- mosunetuzumab
- mycophenolate mofetil
- naltrexone
- naratriptan
- nevirapine
- odevixibat
- olutasidenib
- omaveloxolone
- orphenadrine
- oxcarbazepine
- palovarotene
- paroxetine
- passion flower
- perampanel
- pheniramine
- polyethylene glycol
- polyethylene glycol/electrolytes
- prednisone
- pyrilamine
- ramelteon
- revefenacin inhaled
- rivastigmine
- rizatriptan
- roflumilast
- roflumilast topical
- rufinamide
- sarilumab
- scopolamine
- selinexor
- sertraline
- sirolimus topical
- sodium picosulfate
- sofpironium topical
- solifenacin
- solriamfetol
- sulfate bowel prep
- sumatriptan
- sunvozertinib
- suzetrigine
- tasimelteon
- tazemetostat
- tecovirimat
- telotristat ethyl
- thiotepa
- tiagabine
- tiotropium inhaled
- tocilizumab
- tolterodine
- topiramate
- tovorafenib
- trihexyphenidyl
- triprolidine
- trospium
- umeclidinium inhaled
- vaborbactam
- valbenazine
- valerian
- valproic acid
- vamorolone
- venlafaxine
- vigabatrin
- vilazodone
- vorasidenib
- zolmitriptan
- zonisamide
Adverse Reactions .
Serious Reactions
- angioedema
- stroke
- neuroleptic malignant syndrome
- tardive dyskinesia
- hyperglycemia
- diabetes mellitus
- leukopenia
- neutropenia
- agranulocytosis
- hypotension, orthostatic
- syncope
- QT prolongation
- seizures
- hyperthermia
- suicidality
- hypomania
- mania
- dysphagia, severe
- priapism (peds pts)
Common Reactions
- somnolence
- akathisia
- nausea
- extrapyramidal sx
- vomiting
- diarrhea
- dyspepsia
- insomnia
- hyperprolactinemia
- agitation
- anxiety
- weight gain
- dystonia
- dizziness
- fatigue
- back pain
- restlessness
- Cr elevated
- xerostomia
- oropharyngeal pain (peds pts)
- impaired body temperature regulation
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; fasting glucose at baseline if diabetes risk factors, then periodically; CBC w/ diff frequently during initial tx if pre-existing or hx of leukopenia/neutropenia; weight; consider orthostatic vital signs if hypotension risk; sx suicidality, clinical worsening, and/or unusual behavior changes, especially during initial tx or after dose changes
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, esp. in 3rd trimester; no human data available, though risk of neonatal extrapyramidal and withdrawal sx based on human data w/ other antipsychotics; no known risk of teratogenicity or embryo-fetal toxicity based on animal data at 1.5x and 6x MRHD
Pregnancy Registry
encourage pts to enroll in National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or www.womensmentalhealth.org
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: liver primarily; CYP450: 3A4 substrate
Excretion: feces 80%, urine 9%; Half-life: 18h
Subclass: Antipsychotics, 2nd generation ; Bipolar Disorder
Mechanism of Action
exact mechanism of action unknown; antagonizes dopamine D2 receptors, serotonin 5-HT2A receptors, others
Formulary .
No Formulary Selected
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