Latuda

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

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 symptoms of anxiety.

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 antipsychotic malignant syndrome, extrapyramidal symptoms and hyperglycemia.

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

Indications Latudas

1. Schizophrenia: Latuda is used to improve symptoms of schizophrenia, including delusions, hallucinations, confused or dissociated thoughts, and decreased emotional and social functioning.
2. Bipolar Disorder: The main indications for the use of Latuda in bipolar disorder include controlling symptoms of mania (extreme mood elevation, increased energy and activity, aggressiveness) and preventing or reducing symptoms of depression (low mood, loss of interest in usual activities, drowsiness).

Release form

Latuda is usually available as an oral tablet.

Pharmacodynamics

1. Dopamine receptor antagonism: Lurasidone is an antagonist dopamine D2 and D3 receptors. This means that it blocks the action of dopamine, a neurotransmitter associated with the onset of 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 action at serotonin 5-HT1A receptors and antagonist action at 5-HT2A receptors. This may improve cognitive function, mood, and reduce the risk of negative side effects associated with action on dopamine receptors.
3. Effect on the glutamate system: Lurasidone also has an effect on glutamate receptors, although the exact mechanism of this effect 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 usually well absorbed from the gastrointestinal tract after oral administration. Maximum plasma concentrations are usually achieved approximately 1-3 hours after administration.
2. Distribution: Lurasidone has a high degree of binding to plasma proteins (about 99%), mainly to albumin. It has a large volume of distribution, indicating widespread distribution in body tissues.
3. Metabolism: Lurasidone is metabolized in the liver by oxidation and glucuronidation with the participation of cytochrome P450 enzymes. The main metabolite is desmethyllurasidone, which also has D2 and 5-HT2A antagonism activity.
4. Excretion: Most of Latuda's metabolites are excreted through the kidneys (approximately 64%) and intestines (approximately 19%) within a few days after administration.
5. Half-life: The half-life of lurasidone is approximately 18 hours, which means the drug can accumulate when taken daily.
6. Food: Food may reduce 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 between patients depending on factors such as age, gender, the presence of liver or kidney pathologies, and the use of other drugs.
8. Interactions: Lurasidone may interact with other drugs, especially other psychotropic drugs, and this may affect its pharmacokinetics and/or pharmacodynamics.

Dosing and administration

1. Dosage:

   • The usual starting dose of Latuda for adults in 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, with subsequent increases to 40 mg depending on the effectiveness and tolerability of the drug.
   • The maximum recommended dose of Latuda is usually 80 mg per day.

2. Method of application:

   • Latuda tablets are usually taken orally, regardless of meals.
   • They can be swallowed whole with water, without chewing.
   • It is recommended to take Latuda at the same time every day 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 the possible occurrence of withdrawal syndrome.

Use Latudas during pregnancy

The use of Latuda during pregnancy requires caution, since data on its safety for the fetus are limited. In studies evaluating the safety of secondary antipsychotics during pregnancy, lurasidone did not show an increased risk of major birth defects, but due to the lack of large data on lurasidone, additional 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 to monitor drug levels and adjust dosage to maximize effectiveness and minimize side effects (Montiel et al., 2021). p>

Consequently, the use of lurasidone during pregnancy should be done with caution and under close medical supervision. If the use of lurasidone is necessary, the potential risks and benefits, as well as the possibility of using alternative therapeutic methods, should be considered.

Contraindications

1. Hypersensitivity: People with a known hypersensitivity to lurasidone or other components of the drug should not use Latuda.
2. Use in children: The effectiveness 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: Pregnant or breastfeeding women should discuss the use of Latuda with their physician. This is important because there is limited data on the safety of lurasidone in these cases.
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. Liver impairment: Latuda dosage adjustment may be required in patients with severely impaired liver function.
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 Latudas

1. Drowsiness or daytime sleepiness: Many patients may experience fatigue, drowsiness, or daytime sleepiness while taking Latuda. This may reduce concentration and affect your ability to drive and perform other tasks that require alertness.
2. Extrapyramidal symptoms: These include tremors, muscle stiffness, inability to control movements (akathisia), and even later dyskinesia (unusual movements that often impair muscle control).
3. Lowered blood pressure: Some people may experience a decrease in blood pressure when taking Latuda, which may cause dizziness or a feeling of weakness.
4. Increased blood sugar levels: Latuda may increase blood sugar levels, which is especially important for patients with diabetes.
5. Elevated levels of cholesterol and triglycerides: Some patients may experience increased levels of cholesterol and triglycerides in the blood.
6. Increased prolactin: Latuda can cause increased levels of prolactin in the blood, which can lead to problems with hormonal balance and milk flow 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: Potentially increased serious side effects such as akinesia, extrapyramidal symptoms (motor disturbances), seizures, cardiovascular complications (eg, arrhythmias), and others.
3. Potentially fatal consequences: In case of significant overdose, a potentially fatal condition can occur, especially if the functions of 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, amidarone, quinidine), antidepressants (eg, citalopram, fluoxetine) or antimicrobials (eg, macrolides, azoles), which also increase the QT interval, may increase the risk of developing cardiac arrhythmias.
2. Drugs that have a sedative effect: Lurasidone may enhance the sedative effect of other centrally acting drugs such as benzodiazepines, alcohol, sedating antihistamines and strong analgesics. This can lead to increased drowsiness and depression of the central nervous system.
3. Drugs affecting the cytochrome P450 system: Lurasidone is metabolized in the liver through the cytochrome P450 system. Therefore, drugs that induce (eg, carbamazepine, rifampicin) or inhibit (eg, ketoconazole, clarithromycin) this system may alter blood levels of lurasidone.
4. Drugs that reduce stomach acid: Drugs that reduce gastric acid (eg, antacids, proton pump inhibitors) may reduce the absorption of lurasidone from the gastrointestinal tract, which may reduce its effectiveness.
5. Drugs that affect blood potassium levels: Lurasidone may increase blood potassium levels. Combination with other drugs, such as potassium-sparing diuretics or angiotensin-converting enzyme inhibitors (ACEIs), may lead to hyperkalemia.