Is it safe to take lithium and Latuda together?

In this article:

• Can you take lithium and Latuda together?
• Taking lithium and Latuda together
• Is lithium or Latuda better?

In this article

• Can you take lithium and Latuda together?
• Taking lithium and Latuda together
• Is lithium or Latuda better?

Lithium is a generic prescription drug approved by the Food and Drug Administration (FDA) for people ages 7 years and older for the treatment and prevention of manic episodes associated with bipolar I disorder—a mental health condition characterized by episodes of intense mood swings. It’s a relatively low-cost maintenance treatment that has been around for a long time, according to psychiatrist Sid Khurana, MD, the medical director and co-founder of Nevada Mental Health. 

Latuda (lurasidone) is a brand-name atypical antipsychotic manufactured by Sunovion Pharmaceuticals Inc. Latuda is FDA approved for the treatment of schizophrenia in people ages 13 years and older and for depressive episodes associated with bipolar 1 disorder (bipolar depression) in people ages 10 years and older as a monotherapy. Latuda can also be used as an adjunctive therapy in combination with lithium or valproate for bipolar depression. 

Can you take lithium and Latuda together?

Yes, you can take lithium and Latuda together for bipolar depression. “They can complement each other well,” Dr. Khurana says. 

Results from a clinical trial published in The American Journal of Psychiatry suggest that taking lurasidone with lithium significantly improved depressive symptoms in bipolar disorder. Study participants took 20–60 milligrams (mg) of lurasidone daily in addition to their prescribed lithium dose. 

A recent study also found that the two medications were effective and well-tolerated when taken together. Data was pooled from two six-week studies in which patients with bipolar depression took 20–120 mg of lurasidone daily with their regularly prescribed lithium dose. 

Taking lithium and Latuda together

There are no known interactions between lithium and Latuda. Taking them together is considered generally safe when under the guidance of a licensed medical provider—usually a psychiatrist.

“If someone is at the point where they need to take both Latuda and lithium, in my opinion, they should be under the case of a psychiatrist so that the psychiatrist could monitor the serotonin and some of the severe adverse effects of Latuda, like serotonin syndrome or neuroleptic malignant syndrome,” Dr. Khurana explains. 

Both lithium and Latuda affect brain chemicals, such as serotonin and dopamine. Changes in brain chemistry can sometimes trigger or worsen suicidal thoughts or tendencies. Alert a healthcare professional if someone taking lithium and Latuda together displays abnormal behaviors or experiences suicidal ideations.

“When prescribed any medication, it’s always important to talk with your physician about the possible side effects as well as the expected results—and the timeframe for the expected results,” says Carla Marie Manly, Ph.D., a clinical psychologist and author of Joy from Fear. She also recommends telling the pharmacist who fills your prescription that it is your first time taking lithium or Latuda, since pharmacists may point out important elements of a medication that a healthcare provider may overlook.

Generally, the best practices for taking lithium and Latuda together are the same as the best practices for taking them individually:

• Tell your healthcare provider if you have plans to become pregnant. It is not safe to take lithium during pregnancy. Anyone taking lithium, Latuda, or both should tell their healthcare provider right away if they become pregnant or start breastfeeding.
• Track your symptoms and side effects. “It’s helpful to keep a daily diary of your experiences—both positive and negative,” Dr. Manly says. “Your notes can include important factors such as shifts in mood, changes in appetite, sleep disturbances, or other side effects.” She adds that it may be helpful to ask a trusted friend or family member to track your moods and symptoms, too, especially when starting a new medication for a mental health condition.
• Report serious side effects to your healthcare provider. There are no known drug interactions between lithium and Latuda. However, taking these drugs together may increase the risk of serotonin syndrome, a dangerous condition in which too much serotonin builds up in the body. Symptoms include agitation, disorientation, fever, and more. 

“Although it may be tempting to adjust your dosages on your own, always confer with your doctor before making any changes to your medication routine,” Dr. Manly cautions.

Is lithium or Latuda better?

Both lithium and Latuda are effective treatments for bipolar disorder, although they treat different symptoms of the condition.

RELATED: Latuda vs. lithium: Differences, similarities & side effects

A recent meta-analysis published in BJPsych Open found that about two-thirds of bipolar disorder patients taking lithium had a significant improvement in manic or depressive symptoms. More than 50% of study participants achieved remission.

A placebo-controlled study published in 2020 in Psychiatry and Clinical Neurosciences found that participants with bipolar depression who took a 20–60 mg dose of lurasidone (generic Latuda) daily had significantly reduced depressive symptoms and improved functioning.

Dr. Khurana says that there is no hands-down better option between the two since it depends on multiple factors, such as a patient’s psychiatric history, medical history, and diagnosis. What is better for one patient may not be better for another.

Drug class

lithium, Latuda, and other treatments for bipolar disorder or depression are often referred to colloquially as mood stabilizers. However, that is not the technical drug classification for these medicines. 

Officially, Latuda is a brand-name version of lurasidone, an atypical antipsychotic. Because Latuda is processed by a liver enzyme called CYP3A4, it should not be taken with strong CYP3A4 inhibitors or strong CYP3A4 inducers, such as carbamazepine.

Lithium is classified as an antimanic drug. Depending on the concentrations, lithium may not be safe to take with certain ACE inhibitors (blood pressure medications) or diuretics.

Side effects

Nausea is the most commonly reported side effect of both lithium and Latuda. Taking these drugs together may increase the risk of nausea and other gastrointestinal symptoms.

Dr. Khurana says that the central nervous system (CNS) effects of lurasidone include restlessness or an urge to get up and move around, called akathisia. Once the initial side effects have subsided, he says that the main concerns are weight gain and changes in blood glucose or cholesterol.

“For patients on lithium, sometimes, the stomach side effects can be there, but we also want to make sure we monitor for acne, skin changes, thyroid dysfunction, and kidney dysfunction, and we do that by monitoring the blood,” Dr. Khurana says.

Risks

Even though lithium and Latuda are both effective treatments for bipolar disorder, they’re not right for everyone. Healthcare providers consider many factors when choosing the best treatment for mood disorders, including antidepressants and antipsychotic agents. 

Taking Latuda comes with a risk of serotonin syndrome and neuroleptic malignant syndrome, two uncommon but dangerous conditions associated with serotonergic agents and antipsychotics. The drug has a boxed warning about suicidal thoughts and behaviors. Latuda is also not safe for older adults with dementia-related psychosis. 

Lithium has a boxed warning stating that taking too much of the drug can result in lithium toxicity, a serious, potentially fatal situation. In rare cases, lithium may also cause an adverse event called lithium-induced parkinsonism.

Cost

As a brand-name prescription drug, Latuda costs $1,858.91 for 30, 40 mg tablets. Lithium carbonate, an older generic drug, costs $28.23 for 90, 300 mg capsules. 

That said, comparing lithium and Latuda is not a matter of comparing medications that perform the same function. You cannot swap one for the other. People with bipolar disorder who are concerned about the cost of multiple medications should get medical advice from their prescriber. There may be cheaper alternatives to Latuda, or there may be discount programs for patients who are uninsured or underinsured. 

For people with bipolar disorder, healthcare providers typically prescribe lifelong mood stabilizer treatment. Talk with your healthcare provider about how long you should take Latuda and lithium together based on your specific symptoms.