Highlighting uses, dosage, reviews, how to take & discontinue, side effects, pros & cons, and more

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> Latuda


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Brand & Generic Names; Drug Classes

US brand name: Latuda
Generic name: lurasidone

Drug Class(es)

Primary drug class: Antipsychotics
Additional drug class(es): Second Generation Antipsychotic / Atypical Antipsychotic (SGA / AAP), MoodStabilizers, Antidepressants

Approved & Off-Label Uses (Indications)

Latuda’s US FDA Approved Treatment(s)

  • Schizophrenia
  • Bipolar Depression (officially: Depressive episodes associated with Bipolar I Disorder)

Uses Approved Overseas but not in the US

Off-Label Uses of Latuda

  • Bipolar 2 (seriously, that’s an off-label prescription)
  • as a full-on Bipolar mood-stabilizer
  • As an add-on to an antidepressant to treat depression

When & If Latuda Will Work

Latuda’s Usual Onset of Action (when it starts working)

Like most antipsychotics you should feel Latuda doing something positive within one or two days.

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Likelihood of Working

I’m still researching this.

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Taking and Discontinuing

How to Take Latuda

Sunovion’s recomendation:

The recommended starting dose of LATUDA is 40 mg once daily. Initial dose titration is not required. LATUDA has been shown to be effective in a dose range of 40 mg/day to 160 mg/day. The maximum recommended dose is 160 mg/day.

 Latuda PI sheet

Given how freaking potent Latuda is, and that they make a 20mg tablet, starting with 20mg is something worth discussing with your doctor. It all depends on how crazy you are at the moment, or if you’re currently taking an antipsychotic and the plan is to switch you to Latuda.

You must take Latuda with food, at least 350 calories. Sunovion has now spelled out this requirement as clearly as Pfizer has with Geodon. If you don’t take your Latuda with food it’s the same as if you’re taking a little less than half of your dosage.

While it’s usually a toss-up as to if you should take some in the morning or at night, based on what little I’ve found out, start by taking it in the morning. Latuda might still put you to sleep, but the odds are in favor of it waking you up more than knocking you out.

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How to Stop Taking Latuda (discontinuation / withdrawal)

Reduce your dosage by 20 to 40mg a day every five days to a week.

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Latuda’s Pros and Cons

Pros

  • Latuda’s mechanisms of action promise fewer of the annoying side effects associated with SGAs/AAPs, especially weight gain and the anticholinergic side effects.
  • For a medication with such potent anti-dopamine action, Latuda had surprisingly little affect on prolactin, blood sugar, cholesterol, and triglycerides. For many people in the clinical trials and follow-up studies, Latuda actually lowered the amount of bad cholesterol and triglycerides.
  • As one of the few crazy meds with a pregnancy category of B Latuda is safer to take than than practically every other drug discussed on this site if you’re considering to get, or happen to become, pregnant.


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Cons

  • Any antipsychotic with no anticholinergic side effects is more likely to cause movement disorders.
    • It gives Risperdal, Invega, and some of the more potent first-generation APs (fluphenazine e.g.) some real competition in the King of Movement disorders contest.
  • When it comes to side effects, the results from clinical trials and follow-up studies don’t always map to reality.
  • While it didn’t affect their little babies, noticeably more female mice given the equivalent of a human taking the maximum dosage 160mg a day developed the rodent equivalent of breast cancer.


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Interesting Stuff your Doctor Probably didn’t Tell You about Latuda


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Best Known for


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Latuda’s Side Effects

Typical Side Effects

Movement disorders. Movement disorders galore. 20–40% of the people in the clinical trials had some form of movement disorder, and the rate of side effects in clinical trials are almost always lower than real life.
Nausea and other GI problems are common, but that’s often the case with any made you really need to take with food. Putting you to sleep and making you feel tired throughout the day is also common, but Latuda’s an antipsychotic, so what can you expect?

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Uncommon Side Effects


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Freaky Rare Side Effects


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What You Really Need to be Careful About

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Pregnancy Category

B-proven safe, but not as well tested as A
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Pharmacology

Latuda’s Half-Life & How Long Until It Clears Your System

Plasma half-life: 18 hours. Cleared in approximately 5 days.

Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream1, so there’s nothing swimming around to attach itself to your brain and start doing stuff. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what2, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood.

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Steady State

Steady state is reached in: 7 days.

Steady state is the flipside of half-life. This is when you can expect to get over side effects caused by fluctuating amounts of a medication in your bloodstream. Often, but not always the same amount of time as the plasma clearance above.

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How lurasidone Works

the current best guess at any rate
According to Sunovion, the same as all SGAs / AAPs when it comes to schizophrenia:

[T]hrough a combination of central dopamine Type 2 (D2) and serotonin Type 2 (5HT2A) receptor antagonism. Latuda PI sheet

In English: Blocking excess brain juice at the bits of your brain responsible for both the positive symptoms (the dopamine receptors) of schizophrenia, like delusions and hallucinations, and its negative symptoms and bipolar depression (the serotonin receptors). The effect on

Latuda is a really potent D2 antagonist. It’s also a really potent 5HT7 antagonist, which explains why it knocks some people out when it doesn’t touch H1 histamine receptors. Like Saphris, Latuda doesn’t touch M1 muscarinic receptors. Latuda is also a moderate partial 5HT1A agonist like Geodon and Seroquel. Latuda’s effect on 5HT1A, 5HT2A and 5HT7 explain why it’s a pretty good antidepressant and helps with negative symptoms.
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Active Ingredient

lurasidone hydrochloride

The active ingredient is usually the same as the generic name, but more often than not it’s a chemical salt of the substance identified as the generic. E.g. Fluoxetine is the generic for Prozac, but the active ingredient is fluoxetine hydrochloride (or HCl). It usually doesn’t make much of a difference outside of the more esoteric aspects of a drug’s pharmacology, but not always.


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Shelf Life


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Latuda’s Noted Drug-Drug, Drug-Food & Drug-Supplement Interactions

Don’t even think about drinking grapefruit juice, eating grapefruit, or anything else discussed on our page about such things. That goes double for taking meds that inhibit or induce CYP3A4.

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Check for Other Drug-Drug, Drug-Food & Drug-Supplement Interactions

Drugs.com’s drug-drug and drug-food interaction checker

It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on teh Faecesbooks.
Learn more about drug-everything interactions on our page of tips about taking crazy meds.

Name, Address, Serial Number (Generic and Overseas Availability)

Available in the US as a generic? No

Other Trade Names and Overseas Availability

Available in Canada as Latuda. Approval pending in Britain, Ireland, the EU, and Japan. That last one is funny since it was developed in Japan long before it was approved in the US.
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Shapes & Sizes (How Supplied)

Tablets. 20, 40, 80 & 120 mg.
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Comments, PI Sheet, Ratings, Reviews and More

Comments

Like most of Crazymeds, this article isn’t done. I was most of the way through when my life fell apart on 2 September 2013. As it has been in the wiki’s directory and publicly readable, Google and everyone else on the planet could find it. Given the ratings the article has received, I’m putting out here and working on it when I can.

Latuda was approved by the FDA to treat schizophrenia 28 October 2010 and bipolar depression 28 June 2013.

I’ve got to give props to Sunovion for how well the official Latuda site is geared towards the schizophrenic community, with families & caregivers as an adjunct, but still out in the open. In the way people with all sorts of brain cooties are encouraged to have a support network who aren’t afraid to be associated with them. Like similar well-made sites (e.g. the Invega Sustenna site), the Latuda site treats the schizophrenic as adults, able to read at a high-school level, and capable of making their own decisions when it comes to medication.

Now that Latuda has been approved to treat bipolar depression, the schizophrenia part of the site has been relegated to a subdirectory, with a small link to it on the all about bipolar home page. That’s not surprising. There’s a shitload more money in bipolar than there is in schizophrenia.

On the flip side, their site for health care professionals is creepy. Why? Compare the pictures of schizophrenic guy on both sites. If that is how some doctors see us, maybe they need to be taking 20mg of Latuda a day as well. On the plus side, Sunovion made available the results from the clinical trials that got Latuda FDA approval. While not as transparent as I’d like, it’s still better than nothing.

Latuda’s side effect profile is really odd. For a drug that kicks practically everyone’s ass at D2 (only some of the older APs like fluphenazine and thiothixene are more potent), and has the highest rates for movement disorders I’ve seen in a PI sheet, yet has, based on the information available so far, surprisingly little affect on prolactin, blood sugar, cholesterol, and triglycerides. I’m trying to wrap my head around that one. Maybe its (literally) shitty pharmacokinetics causes all that D2 action to bypass the pancreas and liver. Maybe it manages to exert its action at the serotonin receptors there much better than other APs, compensating for the D2 antagonism. Maybe some of both. Maybe it’s something else entirely - like Stahl’s “x-receptor,” an as-yet-discovered receptor, or property of a known receptor, that affects metabolic functions.

On the subject of side effects, here’s a great bit of refreshing honesty from a drug company:

There is an unmet need in the treatment of schizophrenia for effective medications with fewer adverse effects. --Lurasidone in the treatment of schizophrenia: a 6-week, placebo-controlled study

Too bad the adverse reactions the R&D guys at Dainippon Sumitomo focused on were EPS and other movement disorders. Ooops. No wonder only a third of the people in the study completed it. And Latuda was approved in the US before Japan, where it was developed.

The activity of LATUDA is primarily due to the parent drug. The pharmacokinetics of LATUDA is dose-proportional within a total daily dose range of 20 mg to 160 mg. Steady-state concentrations of LATUDA are reached within 7 days of starting LATUDA.

Following administration of 40 mg of LATUDA, the mean (%CV) elimination half-life was 18 (7) hours.

Absorption and Distribution: LATUDA is absorbed and reaches peak serum concentrations in approximately 1–3 hours. It is estimated that 9–19% of an administered dose is absorbed. Following administration of 40 mg of LATUDA, the mean (%CV) apparent volume of distribution was 6173 (17.2) L. LATUDA is highly bound (~99%) to serum proteins.

In a food effect study, LATUDA mean Cmax and AUC were about 3-times and 2-times, respectively, when administered with food compared to the levels observed under fasting conditions. LATUDA exposure was not affected as meal size was increased from 350 to 1000 calories and was independent of meal fat content [see Dosage and Administration (2.2)].

In clinical studies, establishing the safety and efficacy of LATUDA, patients were instructed to take their daily dose with food [see Dosage and Administration (2.2)].

Metabolism and Elimination: LATUDA is metabolized mainly via CYP3A4. LATUDA is metabolized into two active metabolites (ID-14283 and ID-14326) and two major non-active metabolites (ID-20219 and ID-20220).

Total excretion of radioactivity in urine and feces combined was approximately 89%, with about 80% recovered in feces and 9% recovered in urine, after a single dose of [14C]-labeled LATUDA.

Following administration of 40 mg of LATUDA, the mean (%CV) apparent clearance was 3902 (18.0) mL/min.


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Rate Latuda

Give your overall impression of Latuda on a scale of 0 to 5. Detailed ratings and reviews are available on the Latuda Ratings & Reviews Page.

Get all critical about Latuda

3.5 stars Rating 3.3 out of 5 from 88 criticisms.
Vote Distribution: 12 – 6 – 5 – 11 – 26 – 28


Rate this article

If you’re still feeling judgmental as well as just mental3, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Latuda (lurasidone) Synopsis

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Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, and Other Sites that may be of Interest

Discussion board

If you have any questions not answered here, please see the Crazymeds Latuda discussion board.
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References

Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition by Stephen M. Stahl © 2008 Published by Cambridge University Press.
Stahl’s Illustrated Antipsychotics: Treating Psychosis, Mania and Depression Second Edition by Stephen M. Stahl and Laurence Mignon © 2010 Published by Cambridge University Press.
Latuda PI sheet
Lurasidone for Schizophrenia: A Brief Review of a New Second-Generation Antipsychotic
Lurasidone in the Treatment of Schizophrenia: A Randomized, Double-Blind, Placebo- and Olanzapine-Controlled Study
Clinical potential of lurasidone in the management of schizophrenia
Pharmacological Profile of Lurasidone, a Novel Antipsychotic Agent with Potent 5-Hydroxytryptamine 7 (5-HT7) and 5-HT1A Receptor Activity
Update on the development of lurasidone as a treatment for patients with acute schizophrenia
Lurasidone HCl (Latuda), an Oral, Once-Daily Atypical Antipsychotic Agent for the Treatment of Patients with Schizophrenia


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1 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady state if they can't get, or won't provide a number for that.

2 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.

3 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!


If you have any questions not answered here, please see the Crazymeds Latuda discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher crazymeds.us


Last modified on Thursday, 27 March, 2014 at 21:21:51 by SomeMedCriticPage Authors , Jerod PooreDate created Tuesday, 14 May 2013 at 09:18:44
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Latuda, and all other drug names on this page and used throughout the site, are a trademark of someone else.

will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




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All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas? I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

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