Names and pronunciation
(loo-ras′i-done) Latuda
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Drug reference
(loo-ras′i-done) Latuda
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Func. class.: Atypical antipsychotic
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Chem. class.: Dopamine-serotonin receptor antagonist derivative
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ACTION: May modulate central DOPaminergic and serotonergic activity; high affinity for DOPamine-D2 receptors, serotonin 5-HT2A receptors; partial ago- nist at serotonin 5-HT1A receptor
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USES: Schizophrenia, depression associated with bipolar disorder I
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeeding, geriatric patients, abrupt discontinuation, ambient temperature increase, breast can- cer, cardiac disease, dehydration, diabetes, ketoacidosis, driving, operating machinery, dysphagia, heart failure, hematologic/ hepatic/renal disease, hypotension, hypo- volemia, MI, infertility, obesity, Parkinson’s disease, seizures, strenuous exercise, stroke, substance abuse, syncope, tardive dyskinesia
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Black Box Warning: Dementia: antipsy- chotics (e.g., lurasidone) not approved for treatment of dementia-related psychosis in geriatric patients; may increase risk of death in this population, children, suicidal ideation Black Box Warning: Dementia: this product is not approved for geriatric pa- tients with dementia-related psychosis Black Box Warning: Suicidal ideation/ children: avoid use in children; there may be increased risk of suicide in young adults (<24 yr) and children; assess for worsening depression, suicidal thoughts/ behaviors; product should be dispensed in small quantities • Weight gain, hyperglycemia, metabolic changes in diabetes • Beers: avoid in older adults except for schizophrenia, bipolar disorder, or short-term use as an antiemetic for chemotherapy; increased risk of stroke, cognitive decline • Pregnancy/breastfeeding: use only if clearly needed; cautious use in breast- feeding; excretion is unknown Black Box Warning: Suicidal ideation/ children: to be aware of and report imme- diately any worsening depression, suicidal thoughts/behaviors, hostility, irritability
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SIDE EFFECTS CNS: Agitation, akathisia, anxiety, dizzi- ness, drowsiness, fatigue, hyperthermia, insomnia, dystonic reactions, pseudopar- kinsonism, restlessness, seizures, sui cidal ideation, syncope, tardive dyskine- sia, vertigo CV: Angina, AV block, bradycardia, hyper- tension, orthostatic hypotension, sinus tachycardia, stroke EENT: Blurred vision ENDO: Diabetes mellitus, ketoacidosis, hyperglycemia, hyperprolactinemia GI: Abdominal pain, diarrhea, dyspepsia, nausea, vomiting, gastritis, weight gain/ loss GU: Amenorrhea, breast enlargement, dysmenorrhea, impotence, dysuria, renal failure HEMA: Agranulocytosis, anemia, leuko penia, neutropenia INTEG: Pruritus, rash MS: Back pain, dysarthria; rhabdomyoly sis (rare) SYST: Angioedema
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INTERACTIONS • Do not use with metoclopramide Increase: hypertensive risk— antihypertensive Increase: lurasidone effect—strong CYP3A4 inhibitors; do not use concurrently Increase: serotonin syndrome, neuro leptic malignant syndrome—SSRIs, SNRIs Increase: sedation, respiratory depres- sion—other CNS depressants, alcohol, opioids; avoid using together Decrease: lurasidone effect—CYP3A4 inducers (carbamazapine, rifampin); do not use concurrently Drug/Herb Decrease: product effect—St. John’s wort; do not use together Drug/Food • Do not use with grapefruit, grapefruit juice
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DOSAGE AND ROUTES Schizophrenia • Adult: PO 40 mg/day, range 40-160 mg/day; for those receiving CYP3A4 in- hibitors max 80 mg/day, do not use with strong CYP3A4 inducers/inhibitors • Child 13-17 yr: PO 40 mg daily, may increase to max 80 mg daily Bipolar Disorder I • Adult: PO 20 mg daily, max 120 mg/ day • Child 10-17 PO 20 mg daily, max 80 mg daily Hepatic/renal dose • Adult: PO CCr <50 mL/min, hepatic disease CTP A start dose 20 mg/day, max 80 mg/day; hepatic disease CTP B start dose 20 mg/day, max 40 mg/day
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Available forms: Tabs 20, 40, 80, 120 mg
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Administer: L • Give with meal of ≥350 calories
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Assess: • Schizophrenia: hallucinations, delu- sions, agitation, social withdrawal; moni- tor orientation, behavior, mood before and periodically during therapy • Temperature regulation: avoid strenu- ous activities, excessive heat, dehydration, concomitant anticholinergic medications; risk of hyperthermia • Coadministration with other CNS de- pressants (opioids): if given together, assess for excessive sedation, slow breathing; avoid concurrent use • AIMS assessment, thyroid function tests, LFTs, lipid panel, electrolytes • EPS: restlessness, difficulty speaking, loss of balance, pill rolling, masklike face, shuffling gait, rigidity, tremors, muscle spasms; monitor before and periodically during therapy; report tar- dive dyskinesia immediately
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Evaluate: • Therapeutic response: decreasing hal- lucinations, delusions, agitation, social withdrawal
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About reason for treatment, expected results; not to use grapefruit juice, alcohol • That lab work will be needed regularly • To avoid hazardous activities until re- sponse is known • To avoid OTC products unless ap- proved by prescriber; serious reactions may occur • To report fast heartbeat, extra beats, trouble breathing, sweating, stiffness, thirst, urinating more than usual • To report EPS symptoms, blood dyscra sias: sore throat, fever, unusual bleeding/ bruising
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PHARMACOKINETICS 99% protein binding; excreted 80% in feces, 9% in urine; elimination half-life 18 hr; 9%-19% absorbed; peak 1-3 hr, steady-state 7 days
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• Adult: PO 40 mg/day, range 40-160 mg/day; for those receiving CYP3A4 in- hibitors max 80 mg/day, do not use with strong CYP3A4 inducers/inhibitors
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• Adult: PO 20 mg daily, max 120 mg/ day
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• Adult: PO CCr <50 mL/min, hepatic disease CTP A start dose 20 mg/day, max 80 mg/day; hepatic disease CTP B start dose 20 mg/day, max 40 mg/day
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