Tips for tapering off lurasidone (Latuda)

[Altostrata]

ADMIN NOTE Also see Dose Equivalents for Second-Generation Antipsychotics

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Lurasidone is a new generation atypical antipsychotic, with the usual adverse effects, including obesity and tardive dyskinesia.
 
General FDA information about Latuda: http://www.drugs.com/pro/latuda.html
 
Latuda is predominantly metabolized by the liver enzyme identified as P450 CYP3A4. Taking other drugs that are processed through this enzyme may cause drug-drug interactions. If you are taking multiple drugs of any type, you may wish to check interactions here http://www.drugs.com/drug_interactions.html
 
Half-life is about 18 hours.

Tablets are available in these dosages:

• 20 mg
• 40 mg
• 60 mg
• 80 mg
• 120 mg

According to this Madison, Wisconsin health insurance company, the tablets can be split:
https://www.pplusic.com/documents/upload/p5347-tablet-splitting-program.pdf
 

Very careful tapering is necessary when you have had psychotic symptoms. Withdrawal symptoms that look like psychosis can appear even in those who never had psychosis. If you have a prior diagnosis of psychosis, emergence of these symptoms from dopamine supersensitivity can cause you to become diagnosed as "relapsed" and re-medicated. Read Psychiatrist: Some patients are better off without antipsychotics...

Reduce by 10% per month to start
Like all psychiatric drugs, if you take lurasidone regularly for a month or more, you are at risk for withdrawal symptoms when you go off. We recommend a gradual taper as with other psychiatric drugs: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.) Read Why taper by 10% of my dosage?

Tapering by cutting up tablets

According to this paper https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440099/

Quote

Aripiprazole and lurasidone are optimal agents for tablet splitting.

See How to cut up tablets or pills (using a pill cutter)
 
For precise measurements of small amounts, you may wish to weigh the fragments see Using a digital scale to measure doses

Using a liquid is much more convenient when tapering by tiny amounts.

 

Use a combination of tablet dosages to taper
You may wish to get all or part of your prescription filled with the 20mg tablets, then split them into quarters to taper by 5mg at a time. This will stay within the 10% guideline until you get to 45mg.
 
After 45mg, you may wish to combine a 20mg tablet and take the rest of your dosage by

• using a digital scale to weigh smaller amounts, see Using a digital scale to measure doses
• having a liquid compounded, see Compounding pharmacies (US, UK, and elsewhere)
• or making a suspension yourself with water, see How to make a liquid from tablets or capsules

When you reach 20mg, you may wish to halve the tablet, then take the rest in measured amounts as above, until you get to 10mg, at which point you probably will wish to take the entire dosage in a liquid you can easily titrate.

 

To get prescriptions covered by insurance for two dosages of a tablet, your doctor probably has to specify "divided doses."

You will probably find using a liquid to be much more convenient when tapering by amounts smaller than 10mg.
 

Make a liquid yourself from tablets or capsules
While lurasidone is only slightly soluble in water, you can make a liquid suspension, see How to make a liquid from tablets or capsules

Use an oral syringe to precisely measure out doses as small as .01mg.

 

Additional information about chemistry of making a lurasidone liquid http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381388/

 

Other data http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=88a244d1-eddb-499c-bee2-e1f49056e78f

 

Drugbank http://www.drugbank.ca/drugs/DB08815
 

Edited November 4, 2023 by Altostrata
updated

[JohnBanes]

Lurasidone has a fairly short halflife of about 18 hours or 20-24 hours, depending on where you look.  Thus its concentration can vary quite a bit throughout the day.  At smaller dosages (e.g., around 5mg), this variation can lead to drastically different rates of receptor occupancy throughout the day.  I am concerned that this may be difficult to go through.  Has anyone thought about dealing with this through splitting administration into two doses daily of a smaller amount rather than dosing once a day?

[Altostrata]

Taking split doses seems a reasonable way to dose Latuda when you get down to low doses.

[ChessieCat]

On 7/29/2021 at 12:31 PM, JohnBanes said:

splitting administration into two doses daily

 

There is information here:

 

dose-splitting-for-interdose-withdrawal-from-short-half-life-drugs