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Atypical (Second-generation) Antipsychotic Pregnancy: Use only if benefit outweighs risk — limited data. Neonatal EPS reported with antipsychotics in third trimester.

Lurasidone

Brand names: Latuda

Adult dose

Dose: Schizophrenia: 37mg OD initially with food; usual range 37–111mg OD; maximum 148mg OD. Bipolar depression (adjunct or monotherapy): 18.5–74mg OD with food.
Route: Oral
Frequency: Once daily with food (at least 350 calories) — absorption reduced by 50% without food
Max: 148mg OD (schizophrenia); 74mg OD (bipolar depression)
Must be taken with a meal of at least 350 calories — bioavailability is significantly food-dependent. Favourable metabolic profile — minimal weight gain and no clinically significant QTc prolongation. Licensed for bipolar depression (as monotherapy or adjunct to lithium/valproate) — NICE recommended. Strong evidence for cognitive function.

Paediatric dose

Route: Oral
Frequency: Once daily with food
Max: 74mg OD
Licensed from age 13 years for schizophrenia in the US (FDA) but not licensed in UK for under-18 years. Seek specialist child and adolescent psychiatry opinion.

Dose adjustments

Renal

eGFR 10–50: maximum 74mg OD. eGFR <10: not recommended.

Hepatic

Moderate hepatic impairment: maximum 74mg OD. Severe: maximum 37mg OD.

Clinical pearls

  • Food requirement is critical — must take with ≥350 calorie meal; advise patients to take with their largest meal of the day; absorption without food is unpredictable and inadequate
  • Bipolar depression: NICE recommends lurasidone as an option for moderate-to-severe bipolar depression — strong evidence from PREVAIL trials
  • Metabolic advantage: unlike olanzapine and quetiapine, lurasidone has minimal effect on weight, glucose, and lipids — preferred when metabolic risk is a concern
  • CYP3A4 interactions are the main prescribing hazard — review all medications before prescribing

Contraindications

  • Concomitant strong CYP3A4 inhibitors (ketoconazole, clarithromycin — contraindicated; 7-fold increase in lurasidone AUC)
  • Concomitant strong CYP3A4 inducers (carbamazepine, rifampicin — avoid; marked reduction in exposure)
  • Hypersensitivity to lurasidone

Side effects

  • Akathisia (most common EPSE)
  • Nausea
  • Somnolence
  • Parkinsonism
  • Agitation
  • Minimal weight gain (advantage over olanzapine/quetiapine)
  • Minimal QTc prolongation (advantage)
  • Hyperprolactinaemia (less than risperidone/amisulpride)

Interactions

  • Strong CYP3A4 inhibitors — contraindicated (ketoconazole, clarithromycin, ritonavir)
  • Strong CYP3A4 inducers — avoid (carbamazepine, phenytoin, rifampicin)
  • Moderate CYP3A4 inhibitors (diltiazem, verapamil) — halve lurasidone dose

Monitoring

  • EPSE assessment (akathisia is most common)
  • Weight and metabolic parameters (periodic — though low risk)
  • ECG if cardiac risk factors
  • Food intake compliance counselling

Reference: BNFc; BNF 90; NICE TA810 (Lurasidone for Bipolar Depression); PREVAIL Trials. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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