Latuda

Latuda, also known as lurasidone, is a drug used in psychiatry to treat schizophrenia and manic or mixed episodes of bipolar disorder in adults. It belongs to a class of atypical dopamine and serotonin antagonists known as antipsychotics or neuroleptics.

Latuda works by blocking certain receptors in the brain, including dopamine D2 and serotonin 5-HT2A receptors. This mechanism of action helps reduce symptoms of mental disorders such as hallucinations, delusions, mood changes, and possibly some anxiety symptoms.

Like all medicines, latuda may cause side effects including drowsiness, dizziness, sleep disturbances, dry mouth, changes in appetite, weight gain, digestive problems, and rare but more serious side effects such as neuroleptic malignant syndrome, extrapyramidal symptoms, and hyperglycemia.

Latuda should only be used as directed by a physician who will evaluate the benefits of its use and the potential risks for each individual patient.

Indications Latuda

1. Schizophrenia: Latuda is used to improve symptoms of schizophrenia, including delusions, hallucinations, slow or disjointed thoughts, and decreased emotional and social functioning.
2. Bipolar Disorder: The primary indications for the use of Latuda in bipolar disorder include control of symptoms of mania (extreme mood elevation, increased energy and activity, aggressiveness) and prevention or reduction of symptoms of depression (low mood, loss of interest in usual activities, sleepiness).

Release form

Latuda is usually available as a tablet for oral administration.

Pharmacodynamics

1. Dopamine receptor antagonism: Lurasidone is a dopamine D2 and D3 receptor antagonist. This means that it blocks the action of dopamine, a neurotransmitter associated with psychosis. Dopamine receptor antagonism helps reduce the positive symptoms of schizophrenia, such as hallucinations and delusions.
2. Partial Serotonin Receptor Agonism: Latuda also has partial agonist activity at serotonin 5-HT1A receptors and antagonist activity at 5-HT2A receptors. This may improve cognitive function, mood, and reduce the risk of negative side effects associated with dopamine receptor activity.
3. Effects on the glutamate system: Lurasidone also has effects on glutamate receptors, although the exact mechanism is not yet fully understood. Glutamate is the major excitatory neurotransmitter in the central nervous system, and its role in the pathophysiology of psychiatric disorders is still being studied.
4. Minimal effects on histamine, muscarinic and α1-adrenergic receptors: Latuda is generally well tolerated and is associated with fewer side effects related to histamine, muscarinic and α1-adrenergic receptor antagonism.

Pharmacokinetics

1. Absorption: Lurasidone is generally well absorbed from the gastrointestinal tract following oral administration. Peak plasma concentrations are usually reached approximately 1-3 hours after administration.
2. Distribution: Lurasidone is highly bound to plasma proteins (approximately 99%), primarily to albumin. It has a large volume of distribution, indicating widespread distribution into body tissues.
3. Metabolism: Lurasidone is metabolized in the liver by oxidation and glucuronidation involving cytochrome P450 enzymes. The major metabolite is desmethyllurasidone, which also has D2 and 5-HT2A antagonist activity.
4. Excretion: Most of Latuda's metabolites are excreted via the kidneys (approximately 64%) and via the feces (approximately 19%) within a few days of administration.
5. Half-life: Lurasidone has a half-life of approximately 18 hours, meaning that the drug may accumulate with daily dosing.
6. Food: Food may decrease the rate and extent of absorption of lurasidone, but this does not usually have a clinically significant effect on its effectiveness.
7. Individual characteristics: The pharmacokinetics of lurasidone may vary among patients depending on factors such as age, gender, liver or kidney disease, and the use of other medications.
8. Interactions: Lurasidone may interact with other drugs, especially other psychotropic agents, and this may affect its pharmacokinetics and/or pharmacodynamics.

Dosing and administration

1. Dosage:

   • The usual starting dose of Latuda for adults for the treatment of schizophrenia is 40 mg once daily. The dose may be adjusted by the doctor depending on the response to treatment and the individual needs of the patient.
   • For the treatment of bipolar disorder, the initial dose may be 20 mg once daily, then increased to 40 mg depending on the drug's effectiveness and tolerability.
   • The maximum recommended dose of Latuda is usually 80 mg per day.

2. Directions for use:

   • Latuda tablets are usually taken by mouth, with or without food.
   • They can be swallowed whole with water, without chewing.
   • It is recommended to take Latuda every day at the same time to maintain a stable level of the drug in the body.

3. Duration of treatment:

   • The duration of treatment with Latuda is determined by the doctor and depends on the nature and severity of the disease, as well as the patient's response to treatment.
   • Discontinuation of Latuda should be done gradually under the supervision of a physician to prevent possible withdrawal symptoms.

Use Latuda during pregnancy

Use of Latuda during pregnancy requires caution as there is limited data on its safety for the fetus. In studies assessing the safety of secondary antipsychotics during pregnancy, lurasidone has not been shown to increase the risk of major birth defects, but due to the lack of large data on lurasidone, further study is needed to refine risk estimates (Cohen et al., 2023).

In a study of perinatal use of lurasidone for the treatment of bipolar disorder, changes in serum lurasidone concentrations were observed during pregnancy, indicating the need for monitoring drug levels and adjusting dosage to maximize efficacy and minimize side effects (Montiel et al., 2021).

Therefore, lurasidone should be used with caution and under close medical supervision during pregnancy. If lurasidone is to be used, the potential risks and benefits should be taken into account, as well as the possibility of using alternative therapeutic methods.

Contraindications

1. Hypersensitivity: People with known hypersensitivity to lurasidone or any other components of the drug should not use Latuda.
2. Use in children: The efficacy and safety of Latuda in children have not been established, so its use in children may require special caution and a doctor's prescription.
3. Use during pregnancy and breastfeeding: Women who are pregnant or breastfeeding should discuss the use of Latuda with their doctor. This is important because there is limited data on the safety of lurasidone in these situations.
4. Cardiovascular disease: If you have serious heart or vascular disease, such as heart failure or hypertension, the use of Latuda may require special monitoring and caution.
5. Alcohol intake: Patients should avoid drinking alcohol while taking Latuda as it may increase central nervous system depression.
6. Hepatic impairment: In patients with severe hepatic impairment, dosage adjustment of Latuda may be required.
7. Use with other medications: Before starting Latuda, patients should tell their doctor about all medications they are taking, including prescription drugs, over-the-counter drugs, and supplements.

Side effects Latuda

1. Daytime drowsiness or sleepiness: Many patients may experience tiredness, drowsiness, or daytime sleepiness while taking Latuda. This may reduce concentration and affect the ability to drive and perform other tasks that require alertness.
2. Extrapyramidal symptoms: These include tremors, muscle rigidity, inability to control movements (akathisia) and even late dyskinesias (unusual movements, often involving muscle control).
3. Decreased Blood Pressure: Some people may experience a decrease in blood pressure while taking Latuda, which may cause dizziness or a feeling of weakness.
4. Increased Blood Sugar: Latuda may increase blood sugar levels, which is especially important for people with diabetes.
5. Increased cholesterol and triglyceride levels: Some patients may experience increased levels of cholesterol and triglycerides in the blood.
6. Increased Prolactin: Latuda may cause increased levels of prolactin in the blood, which may lead to problems with hormonal balance and milk production in women and men.
7. Digestive problems: Some patients may experience gastrointestinal problems such as nausea, vomiting, diarrhea, or constipation.
8. Allergic reactions: In rare cases, allergic reactions such as skin rash, itching, or swelling of the face, lips, or tongue may occur.

Overdose

1. Increased unwanted side effects: This may include drowsiness, dizziness, insomnia, anxiety, agitation, muscle weakness, digestive problems (eg, nausea, vomiting, diarrhea), possible changes in blood pressure and heart rate.
2. Risk of serious side effects: There may be an increase in serious side effects such as akinesia, extrapyramidal symptoms (movement disorders), seizures, cardiovascular complications (eg, arrhythmias), and others.
3. Potentially Fatal Effects: In case of significant overdose, a potentially fatal condition may occur, especially if the cardiovascular and respiratory systems are impaired.

Interactions with other drugs

1. Drugs that prolong the QT interval: Lurasidone may prolong the QT interval. Combination with other drugs such as antiarrhythmics (eg, amidaron, quinidine), antidepressants (eg, citalopram, fluoxetine), or antimicrobials (eg, macrolides, azoles) that also prolong the QT interval may increase the risk of cardiac arrhythmias.
2. Sedative drugs: Lurasidone may enhance the sedative effects of other centrally acting drugs such as benzodiazepines, alcohol, sedating antihistamines, and strong analgesics. This may lead to increased drowsiness and central nervous system depression.
3. Drugs affecting the cytochrome P450 system: Lurasidone is metabolized in the liver via the cytochrome P450 system. Therefore, drugs that induce (eg, carbamazepine, rifampin) or inhibit (eg, ketoconazole, clarithromycin) this system may alter the blood levels of lurasidone.
4. Drugs that reduce gastric acid: Drugs that reduce gastric acid (eg, antacids, proton pump inhibitors) may decrease the absorption of lurasidone from the gastrointestinal tract, which may decrease its effectiveness.
5. Drugs that affect potassium levels in the blood: Lurasidone may increase potassium levels in the blood. Combination with other drugs such as potassium-sparing diuretics or angiotensin-converting enzyme inhibitors (ACEIs) may lead to hyperkalemia.