Lurafic
Lurafic (Lurasidone 20/40/80 mg) — 5-HT7-active atypical for schizophrenia and bipolar depression. metabolically clean — minimal weight, lipid, glucose effect.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer
Lurafic (Lurasidone 20 / 40 / 80 mg) is an atypical antipsychotic for schizophrenia and bipolar depression. Must be taken with food (≥ 350 kcal) — fasting halves absorption and produces treatment failure. Metabolically among the cleanest atypicals.
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What Lurafic is and how it works
Lurafic is a lurasidone tablet supplied by Lupin. Available strengths: 20 / 40 / 80 mg. Lurasidone is a D2/5-HT2A antagonist with additional 5-HT7 antagonism (the 5-HT7 component is the basis for its bipolar-depression indication). It is one of the cleanest atypicals on metabolic markers — minimal weight gain, minimal lipid effect, minimal glucose effect.
Fasting bioavailability of lurasidone is approximately half the fed bioavailability. Patients who skip a meal or take the dose at a small snack reach inadequate plasma levels and frequently appear to “fail” therapy. Take with the largest meal of the day, every day, at the same time. A glass of milk or a small biscuit is not enough — aim for at least 350 kcal of mixed-macronutrient food.
Indications and dosing
| Indication | Starting | Target | Max |
|---|---|---|---|
| Schizophrenia (adult) | 40 mg OD with food | 40–80 mg OD | 160 mg |
| Schizophrenia (adolescent ≥ 13 y) | 40 mg OD with food | 40–80 mg OD | 80 mg |
| Bipolar depression (adult, monotherapy or adjunct) | 20 mg OD with food | 20–60 mg OD | 120 mg |
| Bipolar depression (paediatric ≥ 10 y) | 20 mg OD with food | 20–80 mg OD | 80 mg |
| Renal impairment (CrCl < 50) | 20 mg OD with food | up to 80 mg | 80 mg |
Important safety considerations
All atypical antipsychotics carry an FDA black-box warning for increased mortality (mostly cardiovascular and infectious) when used to treat behavioural disturbance in older adults with dementia. Atypicals are not approved for dementia-related psychosis or agitation. Use in this population is off-label, last-resort, time-limited, and requires explicit risk-benefit conversation.
Akathisia is common at higher doses. EPS (rigidity, tremor, dystonia) less common than first-generation antipsychotics but can occur. Manageable with dose reduction or anticholinergic adjunct.
Avoid concurrent strong CYP3A4 inhibitors (azoles, clarithromycin, ritonavir, grapefruit juice) — they raise lurasidone levels several-fold. Avoid strong inducers (rifampicin, carbamazepine, phenytoin, St John’s wort) — they reduce levels into the ineffective range.
All antidepressant-class indications carry the under-25 suicidality warning.
Common side effects
- Somnolence and sedation — common; usually settles.
- Akathisia — dose-dependent.
- Nausea — first 1–2 weeks; mitigated by food (which is mandatory anyway).
- EPS — uncommon but possible.
- Weight gain — modest, generally less than olanzapine/quetiapine.
- Prolactin — small dose-dependent rise.
- Distinctive negatives: minimal effect on lipids, glucose, QT.
Drug interactions
- Strong CYP3A4 inhibitors — contraindicated.
- Strong CYP3A4 inducers — contraindicated.
- Moderate CYP3A4 inhibitors (diltiazem, verapamil, fluconazole, erythromycin) — halve lurasidone dose; max 40 mg.
- Other CNS depressants — additive sedation.
- Other antipsychotics — additive EPS, prolactin, NMS risk.
Pregnancy, breastfeeding, paediatric
Pregnancy: limited data; weigh against untreated illness. Breastfeeding: insufficient data; generally avoided. Paediatric: licensed from 13 (schizophrenia), 10 (bipolar depression).
Storage
Store at 15–30 °C in original packaging.
Frequently Asked Questions
Why does Lurafic need to be taken with food?
Fasting absorption is approximately half of fed absorption. The food requirement is not optional — patients who take Lurafic on an empty stomach often appear to fail therapy when in fact they are simply under-dosed. The minimum threshold for adequate absorption is approximately 350 kcal of mixed food (a normal meal, not a snack).
Why is Lurafic preferred for bipolar depression?
Lurasidone has FDA approval for bipolar depression as monotherapy or adjunct (PREVAIL-2 trial) — one of only three atypicals with this indication (others are quetiapine and olanzapine-fluoxetine). The 5-HT7 antagonism is thought to underlie the antidepressant effect. Lurasidone is a metabolically cleaner choice than quetiapine or olanzapine for bipolar depression.
Will Lurafic make me gain weight?
Less than olanzapine, clozapine, quetiapine, or risperidone — typically 1–2 kg over 6 months in monotherapy. One of the better metabolic profiles among atypicals.
How long until Lurafic works?
Schizophrenia: positive symptoms typically improve over 2–4 weeks; full effect at 4–6 weeks. Bipolar depression: 2–6 weeks for full effect. Compliance with the food requirement matters — if response is poor, check that doses are being taken with adequate meals.
Can Lurafic be combined with mood stabilisers?
Yes — lurasidone is FDA-approved as an adjunct to lithium or valproate in bipolar depression. Combination is common and well-tolerated.
What about driving on Lurafic?
Sedation is dose-dependent. Most patients on stable doses drive normally; the first 1–2 weeks of titration can impair reaction time.
How is Lurafic different from olanzapine?
Lurasidone has a substantially better metabolic profile (less weight gain, less glucose disturbance, less lipid disturbance) but a slightly higher rate of akathisia and somnolence. Olanzapine is more sedating and has stronger acute antipsychotic effect; lurasidone is preferred for long-term metabolic safety.
Can Lurafic be stopped abruptly?
Generally taper over 1–2 weeks, although withdrawal is mild. The relapse risk in schizophrenia and bipolar disease is the main reason for caution — never stop without prescriber agreement.
Why is grapefruit juice a problem?
Grapefruit juice is a strong CYP3A4 inhibitor. Lurasidone is a CYP3A4 substrate; grapefruit raises levels several-fold, increasing sedation, akathisia, and EPS risk. Avoid grapefruit and grapefruit juice during Lurafic therapy.
Does Lurafic prolong the QT interval?
Less than ziprasidone, less than thioridazine. Lurasidone has a small QT signal but is generally regarded as one of the cleaner atypicals for QT. Pre-treatment ECG is not routinely required but is reasonable in patients with cardiac risk factors.
Other Mental Health Medications
- Aripicon (Aripiprazole — D2 partial agonist)
- Olanzap (Olanzapine — robust antipsychotic)
- Risdone (Risperidone)
- Seroquit (Quetiapine — bipolar depression)
- Atlura (Lurasidone — metabolically clean)
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| Strength | 80 mg |
|---|---|
| Quantity | 30 Tablet/s, 60 Tablet/s, 90 Tablet/s, 180 Tablet/s |
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