TaperCommunitylurasidone
Boxed Warning
Increased mortality in elderly patients with dementia-related psychosis. Suicidality risk in young adults during initial treatment for depression.
Lurasidone is an atypical antipsychotic for schizophrenia and bipolar depression. Lower metabolic burden than olanzapine or quetiapine but akathisia is common. Must be taken with food (≥350 calories) for adequate absorption.
20mg, 40mg, 60mg, 80mg, 120mg tablets
Tablets: 20mg, 40mg, 60mg, 80mg, 120mg
Category B
D2 antagonist; 5-HT2A antagonist; 5-HT7 antagonist; partial agonist at 5-HT1A. Lower H1 and muscarinic activity (less sedation, less anticholinergic burden).
Slow taper, with food (absorption issues at very low doses). Watch for tardive symptoms unmasking on dose reduction.
Lurasidone has a more favorable metabolic profile than older atypicals, but the same tardive and discontinuation considerations apply.
3-7 days after stopping
1-2 weeks
2-4 weeks
Tardive dyskinesia symptoms can emerge or worsen weeks-to-months after taper — and are sometimes permanent
Toxicity
Akathisia, somnolence, EPS, hyperprolactinemia, modest weight/metabolic changes (less than olanzapine/quetiapine), QT prolongation, neuroleptic malignant syndrome.
Pharmacokinetics
Hepatic via CYP3A4 (major).
~99%
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