Lurasidone dosing in moderate hepatic impairment is which of the following?

• A. 10-20 mg/day
• B. 40-60 mg/day
• C. 60-100 mg/day
• D. 20-80 mg/day

Answer: (D)

Lurasidone dosing in moderate hepatic impairment is guided by how liver function changes drug clearance. Lurasidone is primarily metabolized by the liver via CYP3A4, so when hepatic function is moderately impaired, exposure to the drug increases. To balance efficacy with safety, the dose is adjusted downward and titrated carefully rather than using the standard full-dose range.

The range 20-80 mg per day reflects starting at a lower dose (around 20 mg) and, if tolerated and clinically needed, titrating up toward the usual maximum, while staying within limits appropriate for impaired liver function. This approach helps achieve antipsychotic effects while reducing the risk of higher exposure-related adverse effects.

Remember to take lurasidone with food to ensure proper absorption, and be mindful that strong CYP3A4 inhibitors or inducers can further alter levels, necessitating additional dose considerations.

The other ranges either start too high, omit the lower starting dose needed for impairment, or exceed what is typically recommended for moderate hepatic impairment, making them less appropriate.