Dosage Form: tablet, film coated
FULL PRESCRIBING INFORMATION
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of 17 placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature.
Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear.
Latuda is not approved for the treatment of patients with dementia-related psychosis. [see Warnings and Precautions (5.1)].
1. INDICATIONS AND USAGE
Latuda is indicated for the treatment of patients with schizophrenia.
The efficacy of Latuda in schizophrenia was established in four 6-week controlled studies of adult patients with schizophrenia [see Clinical Studies (14.1)].
The effectiveness of Latuda for longer-term use, that is, for more than 6 weeks, has not been established in controlled studies. Therefore, the physician who elects to use Latuda for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient [see Dosage and Administration (2)].
2. DOSAGE AND ADMINISTRATION
. Schizophrenia
The recommended starting dose of Latuda is 40 mg once daily. Initial dose titration is not required. Latuda has been shown to be effective in a dose range of 40 mg/day to 120 mg/day [see Clinical Studies (14.1)]. In the 6-week controlled trials, there was no suggestion of added benefit with the 120 mg/day dose, but there was a dose-related increase in certain adverse reactions. Therefore, the maximum recommended dose is 80 mg/day.
. Administration Instructions
Latuda should be taken with food (at least 350 calories) [see Clinical Pharmacology (12)].
. Dosage in Special Populations
Dosage adjustments are not recommended on the basis of age, gender, and race [see Use in Specific Populations (8)].
Dose adjustment is recommended in moderate and severe renal impairment patients. The dose in these patients should not exceed 40 mg/day [see Use in Specific Populations (8)].
Dose adjustment is recommended in moderate and severe hepatic impairment patients. The dose in these patients should not exceed 40 mg/day [see Use in Specific Populations (8)].
Dosing recommendation for patients taking Latuda concomitantly with potential CYP3A4 inhibitors: When coadministration of Latuda with a moderate CYP3A4 inhibitor such as diltiazem is considered, the dose should not exceed 40 mg/day. Latuda should not be used in combination with a strong CYP3A4 inhibitor (e.g., ketoconazole) [see Contraindications (4); Drug Interactions (7.1)].
Dosing recommendation for patients taking Latuda concomitantly with potential CYP3A4 inducers: Latuda should not be used in combination with a strong CYP3A4 inducer (e.g., rifampin) [see Contraindications (4); Drug Interactions (7.1)].
3. DOSAGE FORMS AND STRENGTHS
Latuda tablets are available in the following shape and color (Table 1) with respective one-sided debossing: 20 mg (white to off-white, round, “L20”), 40 mg (white to off-white, round, “L40”), or 80 mg (pale green, oval, “L80”).
| Tablet Strength | Tablet Color/Shape | Tablet Markings |
|---|---|---|
| 20 mg | white to off-white round | L20 |
| 40 mg | white to off-white round | L40 |
| 80 mg | pale green oval | L80 |
4. CONTRAINDICATIONS
Latuda is contraindicated in any patient with a known hypersensitivity to lurasidone HCl or any components in the formulation. Angioedema has been observed with lurasidone [see Adverse Reactions (6.6)].
Latuda is contraindicated with strong CYP3A4 inhibitors (e.g., ketoconazole) and strong CYP3A4 inducers (e.g., rifampin) [see Drug Interactions (7.1)].
5. WARNINGS AND PRECAUTIONS
. Increased Mortality in Elderly Patients with Dementia-Related Psychosis
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Latuda is not approved for the treatment of dementia-related psychosis [see Boxed Warning].
. Cerebrovascular Adverse Reactions, Including Stroke
In placebo-controlled trials with risperidone, aripiprazole, and olanzapine in elderly subjects with dementia, there was a higher incidence of cerebrovascular adverse reactions (cerebrovascular accidents and transient ischemic attacks), including fatalities, compared to placebo-treated subjects. Latuda is not approved for the treatment of patients with dementia-related psychosis [see also Boxed Warning and Warnings and Precautions (5.1)].
. Neuroleptic Malignant Syndrome
A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with administration of antipsychotic drugs, including Latuda.
Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatinine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure.
The diagnostic evaluation of patients with this syndrome is complicated. It is important to exclude cases where the clinical presentation includes both serious medical illness (e.g., pneumonia, systemic infection) and untreated or inadequately treated extrapyramidal signs and symptoms (EPS). Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever, and primary central nervous system pathology.
The management of NMS should include: 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy; 2) intensive symptomatic treatment and medical monitoring; and 3) treatment of any concomitant serious medical problems for which specific treatments are available. There is no general agreement about specific pharmacological treatment regimens for NMS.
If a patient requires antipsychotic drug treatment after recovery from NMS, the potential reintroduction of drug therapy should be carefully considered. If reintroduced, the patient should be carefully monitored, since recurrences of NMS have been reported.
. Tardive Dyskinesia
Tardive dyskinesia is a syndrome consisting of potentially irreversible, involuntary, dyskinetic movements that can develop in patients treated with antipsychotic drugs. Although the prevalence of the syndrome appears to be highest among the elderly, especially elderly women, it is impossible to rely upon prevalence estimates to predict, at the inception of antipsychotic treatment, which patients are likely to develop the syndrome. Whether antipsychotic drug products differ in their potential to cause tardive dyskinesia is unknown.
The risk of developing tardive dyskinesia and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increase. However, the syndrome can develop, although much less commonly, after relatively brief treatment periods at low doses.
There is no known treatment for established cases of tardive dyskinesia, although the syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn. Antipsychotic treatment, itself, however, may suppress (or partially suppress) the signs and symptoms of the syndrome and thereby may possibly mask the underlying process. The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown.
Given these considerations, Latuda should be prescribed in a manner that is most likely to minimize the occurrence of tardive dyskinesia. Chronic antipsychotic treatment should generally be reserved for patients who suffer from a chronic illness that (1) is known to respond to antipsychotic drugs, and (2) for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate. In patients who do require chronic treatment, the smallest dose and the shortest duration of treatment producing a satisfactory clinical response should be sought. The need for continued treatment should be reassessed periodically.
If signs and symptoms of tardive dyskinesia appear in a patient on Latuda, drug discontinuation should be considered. However, some patients may require treatment with Latuda despite the presence of the syndrome.
. Metabolic Changes
Atypical antipsychotic drugs have been associated with metabolic changes that may increase cardiovascular/cerebrovascular risk. These metabolic changes include hyperglycemia, dyslipidemia, and body weight gain. While all of the drugs in the class have been shown to produce some metabolic changes, each drug has its own specific risk profile.
Hyperglycemia and Diabetes Mellitus
Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics. Assessment of the relationship between atypical antipsychotic use and glucose abnormalities is complicated by the possibility of an increased background risk of diabetes mellitus in patients with schizophrenia and the increasing incidence of diabetes mellitus in the general population. Given these confounders, the relationship between atypical antipsychotic use and hyperglycemia-related adverse events is not completely understood. However, epidemiological studies suggest an increased risk of treatment-emergent hyperglycemia-related adverse events in patients treated with the atypical antipsychotics. Because Latuda was not marketed at the time these studies were performed, it is not known if Latuda is associated with this increased risk.
Patients with an established diagnosis of diabetes mellitus who are started on atypical antipsychotics should be monitored regularly for worsening of glucose control. Patients with risk factors for diabetes mellitus (e.g., obesity, family history of diabetes) who are starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the suspect drug.
Pooled data from short-term, placebo-controlled studies are presented in Table 2.
Placebo | Latuda 20 mg/day | Latuda 40 mg/day | Latuda 80 mg/day | Latuda 120 mg/day | |
|---|---|---|---|---|---|
| Mean Change from Baseline (mg/dL) | |||||
| n=438 | n=71 | n=352 | n=270 | n=283 | |
| Serum Glucose | -0.7 | -0.6 | 2.5 | -0.9 | 2.5 |
| Proportion of Patients with Shifts to ≥ 126 mg/dL | |||||
| Serum Glucose (≥ 126 mg/dL) | 8.6% (34/397) | 11.7% (7/60) | 14.3% ( 47/328) | 10.0% (24/241) | 10.0% (26/260) |
In the uncontrolled, longer-term studies (primarily open-label extension studies), Latuda was associated with a mean change in glucose of +1.6 mg/dL at week 24 (n=186), +0.3 mg/dL at week 36 (n=236) and +1.2 mg/dL at week 52 (n=244).
Dyslipidemia
Undesirable alterations in lipids have been observed in patients treated with atypical antipsychotics. Pooled data from short-term, placebo-controlled studies are presented in Table 3.
Placebo | Latuda 20 mg/day | Latuda 40 mg/day | Latuda 80 mg/day | Latuda 120 mg/day | |
| Mean Change from Baseline (mg/dL) | |||||
| n=418 | n=71 | n=341 | n=263 | n=268 | |
| Total cholesterol | -8.5 | -12.3 | -9.4 | -9.8 | -3.8 |
| Triglycerides | -15.7 | -29.1 | -6.2 | -14.2 | -3.1 |
| Proportion of Patients with Shifts | |||||
| Total cholesterol (≥ 240 mg/dL) | 6.6% (23/350) | 13.8% (8/58) | 7.3% (21/287) | 6.9% (15/216) | 3.8% (9/238) |
| Triglycerides (≥ 200 mg/dL) | 12.5% (39/312) | 14.3% (7/49) | 14.0% (37/264) | 8.7% (17/196) | 10.5% (22/209) |
In the uncontrolled, longer-term studies (primarily open-label extension studies), Latuda was associated with a mean change in total cholesterol and triglycerides of -4.2 (n=186) and -13.6 (n=187) mg/dL at week 24, -1.9 (n=238) and -3.5 (n=238) mg/dL at week 36 and -3.6 (n=243) and -6.5 (n=243) mg/dL at week 52, respectively.
Weight Gain
Weight gain has been observed with atypical antipsychotic use. Clinical monitoring of weight is recommended.
Pooled data from short-term, placebo-controlled studies are presented in Table 4. The mean weight gain was 0.75 kg for Latuda-treated patients compared to 0.26 kg for placebo-treated patients. In Study 3 [see Clinical Studies (14.1)] change in weight from baseline for olanzapine was 4.15 kg. The proportion of patients with a ≥ 7% increase in body weight (at Endpoint) was 5.6% for Latuda-treated patients versus 4.0% for placebo-treated patients.
Placebo (n=450) | Latuda 20 mg/day (n=71) | Latuda 40 mg/day (n=358) | Latuda 80 mg/day (n=279) | Latuda 120 mg/day (n=291) | |
|---|---|---|---|---|---|
| All Patients | 0.26 | -0.15 | 0.67 | 1.14 | 0.68 |
In the uncontrolled, longer-term studies (primarily open-label extension studies), Latuda was associated with a mean change in weight of -0.38 kg at week 24 (n=531), -0.47 kg at week 36 (n=303) and -0.71 kg at week 52 (n=244).
. Hyperprolactinemia
As with other drugs that antagonize dopamine D2 receptors, Latuda elevates prolactin levels.
Hyperprolactinemia may suppress hypothalamic GnRH, resulting in reduced pituitary gonadotrophin secretion. This, in turn, may inhibit reproductive function by impairing gonadal steroidogenesis in both female and male patients. Galactorrhea, amenorrhea, gynecomastia, and impotence have been reported with prolactin-elevating compounds. Long-standing hyperprolactinemia when associated with hypogonadism may lead to decreased bone density in both female and male patients [see Adverse Reactions (6)].
In short-term, placebo-controlled studies, the median change from baseline to endpoint in prolactin levels for Latuda-treated patients was 1.1 ng/mL and was - 0.6 ng/mL in the placebo-treated patients. The increase in prolactin was greater in female patients; the median change from baseline to endpoint for females was 1.5 ng/mL and was 1.1 ng/mL in males. The increase in prolactin concentrations was dose-dependent (Table 5).
| Placebo | Latuda 20 mg/day | Latuda 40 mg/day | Latuda 80 mg/day | Latuda 120 mg/day | |
| All Patients | -0.6 (n=430) | -1.1 (n=70) | 0.3 (n=351) | 1.1 (n=259) | 3.3 (n=284) |
| Females | -1.5 (n=102) | -0.7 (n=19) | -0.9 (n=99) | 2.0 (n=78) | 6.7 (n=70) |
| Males | -0.5 (n=328) | -1.2 (n=51) | 0.5 (n=252) | 0.9 (n=181) | 3.1 (n=214) |
The proportion of patients with prolactin elevations ≥ 5× ULN was 3.6% for Latuda-treated patients versus 0.7% for placebo-treated patients. The proportion of female patients with prolactin elevations ≥ 5x ULN was 8.3% for Latuda-treated patients versus 1% for placebo-treated female patients. The proportion of male patients with prolactin elevations > 5x ULN was 1.9% versus 0.6% for placebo-treated male patients.
In the uncontrolled longer-term studies (primarily open-label extension studies), Latuda was associated with a median change in prolactin of -1.9 ng/mL at week 24 (n=188), -5.4 ng/mL at week 36 (n=189) and -3.3 ng/mL at week 52 (n=243).
Tissue culture experiments indicate that approximately one-third of human breast cancers are prolactin dependent in vitro, a factor of potential importance if the prescription of these drugs is considered in a patient with previously detected breast cancer. As is common with compounds which increase prolactin release, an increase in mammary gland neoplasia was observed in a Latuda carcinogenicity study conducted in rats and mice [see Nonclinical Toxicology (13)]. Neither clinical studies nor epidemiologic studies conducted to date have shown an association between chronic administration of this class of drugs and tumorigenesis in humans, but the available evidence is too limited to be conclusive.
Leukopenia, Neutropenia and Agranulocytosis
Leukopenia/neutropenia has been reported during treatment with antipsychotic agents. Agranulocytosis (including fatal cases) has been reported with other agents in the class.
Possible risk factors for leukopenia/neutropenia include pre-existing low white blood cell count (WBC) and history of drug-induced leukopenia/neutropenia. Patients with a pre-existing low WBC or a history of drug-induced leukopenia/neutropenia should have their complete blood count (CBC) monitored frequently during the first few months of therapy and Latuda should be discontinued at the first sign of decline in WBC, in the absence of other causative factors.
Patients with neutropenia should be carefully monitored for fever or other symptoms or signs of infection and treated promptly if such symptoms or signs occur. Patients with severe neutropenia (absolute neutrophil count < 1000/mm3) should discontinue Latuda and have their WBC followed until recovery.
. Orthostatic Hypotension and Syncope
Latuda may cause orthostatic hypotension, perhaps due to its α1-adrenergic receptor antagonism. The incidence of orthostatic hypotension and syncope events from short-term, placebo-controlled studies was (Latuda incidence, placebo incidence): orthostatic hypotension [0.4% (4/1004), 0.2% (1/455)] and syncope [< 0.1% (1/1004), 0%]. Assessment of orthostatic hypotension defined by vital sign changes (≥ 20 mm Hg decrease in systolic blood pressure and ≥ 10 bpm increase in pulse from sitting to standing or supine to standing positions). In short-term clinical trials orthostatic hypotension occurred with a frequency of 0.8% with Latuda 40 mg, 1.4% with Latuda 80 mg and 1.7% with Latuda 120 mg compared to 0.9% with placebo.
Latuda should be used with caution in patients with known cardiovascular disease (e.g., heart failure, history of myocardial infarction, ischemia, or conduction abnormalities), cerebrovascular disease, or conditions that predispose the patient to hypotension (e.g., dehydration, hypovolemia, and treatment with antihypertensive medications). Monitoring of orthostatic vital signs should be considered in patients who are vulnerable to hypotension.
. Seizures
As with other antipsychotic drugs, Latuda should be used cautiously in patients with a history of seizures or with conditions that lower the seizure threshold, e.g., Alzheimer's dementia. Conditions that lower the seizure threshold may be more prevalent in patients 65 years or older.
In short-term, placebo-controlled trials, seizures/convulsions occurred in < 0.1% (1/1004) of patients treated with Latuda compared to 0.2% (1/455) placebo-treated patients.
. Potential for Cognitive and Motor Impairment
Latuda, like other antipsychotics, has the potential to impair judgment, thinking or motor skills.
In short-term, placebo-controlled trials, somnolence was reported in 22.3% (224/1004) of patients treated with Latuda compared to 9.9% (45/455) of placebo patients, respectively. The frequency of somnolence increases with dose; somnolence was reported in 26.5% (77/291) of patients receiving Latuda 120 mg/day. In these short-term trials, somnolence included: hypersomnia, hypersomnolence, sedation and somnolence.
Patients should be cautioned about operating hazardous machinery, including motor vehicles, until they are reasonably certain that therapy with Latuda does not affect them adversely.
. Body Temperature Regulation
Disruption of the body's ability to reduce core body temperature has been attributed to antipsychotic agents. Appropriate care is advised when prescribing Latuda for patients who will be experiencing conditions that may contribute to an elevation in core body temperature, e.g., exercising strenuously, exposure to extreme heat, receiving concomitant medication with anticholinergic activity, or being subject to dehydration [see Patient Counseling Information (17.9)].
. Suicide
The possibility of a suicide attempt is inherent in psychotic illness and close supervision of high-risk patients should accompany drug therapy. Prescriptions for Latuda should be written for the smallest quantity of tablets consistent with good patient management in order to reduce the risk of overdose.
In short-term, placebo-controlled studies in patients with schizophrenia, the incidence of treatment-emergent suicidal ideation was 0.6% (6/1004) for Latuda-treated patients compared to 0.4% (2/455) on placebo. No suicide attempts or completed suicides were reported in these studies.
. Dysphagia
Esophageal dysmotility and aspiration have been associated with antipsychotic drug use. Aspiration pneumonia is a common cause of morbidity and mortality in elderly patients, in particular those with advanced Alzheimer's dementia. Latuda is not indicated for the treatment of dementia-related psychosis, and should not be used in patients at risk for aspiration pneumonia.
. Use in Patients with Concomitant Illness
Clinical experience with Latuda in patients with certain concomitant systemic illnesses is limited [see Use in Specific Populations (8.6, 8.7)]. Latuda has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable heart disease. Patients with these diagnoses were excluded from premarketing clinical studies [see Warnings and Precautions (5.1, 5.8)].
6. ADVERSE REACTIONS
. Overall Adverse Reaction Profile
The following adverse reactions are discussed in more detail in other sections of the labeling:
- Use in Elderly Patients with Dementia-Related Psychosis [see Boxed Warning and Warnings and Precautions (5.1)]
- Cerebrovascular Adverse Reactions, Including Stroke [see Warnings and Precautions (5.2)]
- Neuroleptic Malignant Syndrome [see Warnings and Precautions (5.3)]
- Tardive Dyskinesia [see Warnings and Precautions (5.4)]
- Hyperglycemia and Diabetes Mellitus [see Warnings and Precautions (5.5)]
- Hyperprolactinemia [see Warnings and Precautions (5.6)]
- Leukopenia, Neutropenia, and Agranulocytosis [see Warnings and Precautions (5.7)]
- Orthostatic Hypotension and Syncope [see Warnings and Precautions (5.8)]
- Seizures [see Warnings and Precautions (5.9)]
- Potential for Cognitive and Motor Impairment [see Warnings and Precautions (5.10)]
- Body Temperature Regulation [see Warnings and Precautions (5.11)]
- Suicide [see Warnings and Precautions (5.12)]
- Dysphagia [see Warnings and Precautions (5.13)]
- Use in Patients with Concomitant Illness [see Warnings and Precautions (5.14)]
The information below is derived from a clinical study database for Latuda consisting of over 2096 patients with schizophrenia exposed to one or more doses with a total experience of 624 patient-years. Of these patients, 1004 participated in short-term, placebo-controlled schizophrenia studies with doses of 20 mg, 40 mg, 80 mg or 120 mg once daily. A total of 533 Latuda-treated patients had at least 24 weeks and 238 Latuda-treated patients had at least 52 weeks of exposure.
Adverse events during exposure to study treatment were obtained by general inquiry and voluntarily reported adverse experiences, as well as results from physical examinations, vital signs, ECGs, weights and laboratory investigations. Adverse experiences were recorded by clinical investigators using their own terminology. In order to provide a meaningful estimate of the proportion of individuals experiencing adverse events, events were grouped in standardized categories using MedDRA terminology.
The stated frequencies of adverse reactions represent the proportion of individuals who experienced at least once, a treatment-emergent adverse event of the type listed. Treatment-emergent adverse events were defined as adverse experiences, which started or worsened on or after the date of the first dose through seven days after study medication discontinuation. There was no attempt to use investigator causality assessments; i.e., all events meeting the defined criteria, regardless of investigator causality are included. It is important to emphasize that, although the reactions occurred during treatment with Latuda, they were not necessarily caused by it. The label should be read in its entirety to gain an understanding of the safety profile of Latuda.
The figures in the tables and tabulations cannot be used to predict the incidence of side effects in the course of usual medical practice where patient characteristics and other factors differ from those that prevailed in the clinical studies. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatment, uses and investigators. The cited figures, however, do provide the prescriber with some basis for estimating the relative contribution of drug and nondrug factors to the adverse reaction incidence in the population studied.
. Clinical Studies Experience
The following findings are based on the short-term, placebo-controlled premarketing studies for schizophrenia in which Latuda was administered at daily doses ranging from 20 to 120 mg (n=1004).
Commonly Observed Adverse Reactions: The most common adverse reactions (incidence ≥ 5% and at least twice the rate of placebo) in patients treated with Latuda were somnolence, akathisia, nausea, parkinsonism and agitation.
Adverse Reactions Associated with Discontinuation of Treatment: A total of 9.4% (94/1004) Latuda-treated patients and 5.9% (27/455) of placebo-treated patients discontinued due to adverse reactions. There were no adverse reactions associated with discontinuation in subjects treated with Latuda that were at least 2% and at least twice the placebo rate.
Adverse Reactions Occurring at an Incidence of 2% or More in Latuda-Treated Patients: Adverse reactions associated with the use of Latuda (incidence of 2% or greater, rounded to the nearest percent and Latuda incidence greater than placebo) that occurred during acute therapy (up to 6 weeks in patients with schizophrenia) are shown in Table 6.
Note: Figures rounded to the nearest integer | ||
* Somnolence includes adverse event terms: hypersomnia, hypersomnolence, sedation, and somnolence | ||
** Parkinsonism includes adverse event terms: bradykinesia, cogwheel rigidity, drooling, extrapyramidal disorder, hypokinesia, muscle rigidity, parkinsonism, psychomotor retardation, and tremor | ||
*** Dystonia includes adverse event terms: dystonia, oculogyric crisis, oromandibular dystonia, tongue spasm, torticollis, and trismus | ||
| Percentage of Patients Reporting Reaction | ||
| Body System or Organ Class Dictionary-derived Term | Placebo (N=455) | All Latuda (N=1004) |
| Gastrointestinal Disorders | ||
| Nausea | 6 | 12 |
| Vomiting | 6 | 8 |
| Dyspepsia | 6 | 8 |
| Salivary Hypersecretion | < 1 | 2 |
| General Disorders and Administration Site Conditions | ||
| Fatigue | 3 | 4 |
| Musculoskeletal and Connective Tissue Disorders | ||
| Back Pain | 3 | 4 |
| Nervous System Disorders | ||
| Somnolence* | 10 | 22 |
| Akathisia | 3 | 15 |
| Parkinsonism** | 5 | 11 |
| Dystonia*** | 1 | 5 |
| Dizziness | 3 | 5 |
| Psychiatric Disorders | ||
| Insomnia | 7 | 8 |
| Agitation | 3 | 6 |
| Anxiety | 3 | 6 |
| Restlessness | 2 | 3 |
. Dose-Related Adverse Reactions
Based on the pooled data from the short-term, placebo-controlled, fixed-dose studies, among the adverse reactions that occurred with a greater than 5% incidence in the patients treated with Latuda, the apparent dose-related adverse reactions were akathisia and somnolence (Table 7).
| Percentage of Subjects Reporting Reaction | |||||
|---|---|---|---|---|---|
| Adverse Event Term | Placebo (N=455) (%) | Latuda 20 mg/day (N=71) (%) | Latuda 40 mg/day (N=360) (%) | Latuda 80 mg/day (N=282) (%) | Latuda 120 mg/day (N=291) (%) |
Note: Figures rounded to the nearest integer | |||||
| Akathisia | 3 | 6 | 11 | 15 | 22 |
| Somnolence* | 10 | 15 | 19 | 23 | 26 |
. Extrapyramidal Symptoms
In the short-term, placebo-controlled schizophrenia studies, for Latuda-treated patients, the incidence of reported EPS-related events, excluding akathisia and restlessness, was 14.7% versus 5.1% for placebo-treated patients; and the incidence of akathisia for Latuda-treated patients was 15.0% versus 3.3% for placebo-treated patients. Akathisia appeared to be dose-related and the greatest frequency of parkinsonism and dystonia occurred with the highest dose of Latuda, 120 mg/day (Table 8).
| Adverse Event Term | Placebo (N=455) (%) | Latuda 20 mg/day (N=71) (%) | Latuda 40 mg/day (N=360) (%) | Latuda 80 mg/day (N=282) (%) | Latuda 120 mg/day (N=291) (%) |
|---|---|---|---|---|---|
Note: Figures rounded to the nearest integer | |||||
* Dystonia includes adverse event terms: dystonia, oculogyric crisis, oromandibular dystonia, tongue spasm, torticollis, and trismus | |||||
** Parkinsonism includes adverse event terms: bradykinesia, cogwheel rigidity, drooling, extrapyramidal disorder, hypokinesia, muscle rigidity, parkinsonism, psychomotor retardation, and tremor | |||||
| All EPS events | 9 | 10 | 24 | 26 | 39 |
| All EPS events, excluding Akathisia/Restlessness | 5 | 6 | 13 | 11 | 22 |
| Akathisia | 3 | 6 | 11 | ||
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