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

• A. 5-15 mg/day
• B. 10-20 mg/day
• C. 40-60 mg/day
• D. 20-40 mg/day

Answer: (D)

In severe hepatic impairment, the body’s ability to clear lurasidone is significantly reduced, leading to higher drug exposure. Lurasidone is mainly metabolized by the liver enzyme CYP3A4, so when liver function is poor, clearance drops and the same dose can accumulate more than expected. To keep exposure within a safe and effective range, the dose is limited to a lower daily amount taken with food. The recommended range in this setting is 20 to 40 mg per day, starting at 20 mg and increasing to 40 mg if needed and tolerated. Doses higher than 40 mg would increase exposure further and raise the risk of adverse effects, while much lower doses may be ineffective. Always monitor response and tolerability when adjusting.