BSN Tracker

lurasidone

Brand: Latuda

⚠ BBW Beers Criteria Prototype: risperidone
Drug Class: second-generation antipsychotic (SGA)
Drug Family: antipsychotic
Subclass: benzisothiazol derivative
Organ Systems: cns

Mechanism of Action

Blocks D2 and 5-HT2A receptors (standard SGA mechanism); additionally antagonizes 5-HT7 receptors (may enhance cognitive and depressive symptom improvement) and partially agonizes 5-HT1A (anxiolytic potential). One of the few antipsychotics with FDA approval for bipolar depression.

D2 dopamine receptor5-HT2A receptor5-HT7 receptor (antagonist)5-HT1A receptor (partial agonist)alpha-2C adrenergic receptor

Indications

  • schizophrenia
  • bipolar I depression (as monotherapy or adjunct to lithium/valproate)

Contraindications

  • concurrent strong CYP3A4 inhibitors or inducers

Adverse Effects

Common

  • akathisia
  • somnolence
  • nausea
  • extrapyramidal symptoms
  • agitation

Serious

  • NMS
  • tardive dyskinesia
  • metabolic effects (low weight gain risk)

Pharmacokinetics (ADME)

Absorption bioavailability ~9-19%; food requirement — must be taken with ≥350 calories; food increases AUC by 2-3 fold
Distribution protein binding ~99%; Vd ~6173 L
Metabolism primarily CYP3A4; active metabolites ID-14283 and ID-14326
Excretion fecal (~80%) and renal (~9%)
Half-life 18 hours
Onset several days to weeks
Peak 1-3 hours
Duration 24 hours
Protein Binding 99%
Vd 6173 L

Drug Interactions

Drug / Agent Mechanism Severity
strong CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir) dramatically increase lurasidone levels; contraindicated contraindicated
strong CYP3A4 inducers (rifampin, carbamazepine) dramatically decrease lurasidone levels; contraindicated contraindicated
moderate CYP3A4 inhibitors reduce maximum lurasidone dose to 40 mg/day major

Nursing Considerations

  1. Must be taken with food (≥350 calories); insufficient caloric co-administration reduces AUC by 50%; patient education on this requirement is essential for therapeutic drug levels.
  2. Contraindicated with strong CYP3A4 inhibitors and inducers — verify all concurrent medications before administration; grapefruit juice is also contraindicated.
  3. Lurasidone has a favorable metabolic profile with minimal weight gain, making it preferred in metabolically vulnerable patients.
  4. For bipolar depression (a rare FDA indication for an antipsychotic), educate patients that lurasidone treats the depressive phase; it is not indicated for acute mania.

Clinical Pearls

  • Lurasidone is one of only three SGAs with FDA approval specifically for bipolar depression (along with quetiapine and cariprazine), filling an important gap since most antipsychotics are approved only for mania.
  • Its 5-HT7 antagonism is thought to contribute to antidepressant and pro-cognitive effects, potentially explaining some of its efficacy in bipolar depression beyond D2 blockade.

Safety Profile

Pregnancy use-with-caution
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Bipolar I Depression (as Monotherapy Or Adjunct To Lithium/valproate) Schizophrenia Second-generation Antipsychotic (SGA)
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