What are the guidelines for switching from Invega Sustenna (paliperidone) to Caplyta (lumateperone)?

Guidelines for Switching from Invega Sustenna to Caplyta

When switching from Invega Sustenna (paliperidone palmitate) to Caplyta (lumateperone), a gradual cross-titration approach should be used, informed by the half-life and receptor profile of each medication. 1

Understanding the Medications

Invega Sustenna (Paliperidone Palmitate)

• Long-acting injectable (LAI) antipsychotic with a biphasic pharmacokinetic profile 2
• Has a long half-life, with therapeutic effects lasting approximately one month per injection 3
• Requires special consideration during discontinuation due to its extended release properties 3

Caplyta (Lumateperone)

• Novel oral antipsychotic that acts as a selective and simultaneous modulator of serotonin, dopamine, and glutamate 4
• First-in-class medication with a different mechanism of action compared to traditional antipsychotics 5
• Administered as a daily oral medication 4

Switching Protocol

Timing Considerations

• Begin Caplyta administration when the next scheduled Invega Sustenna injection would have been due 3
• This approach minimizes the risk of withdrawal symptoms or rebound psychosis 1
• For patients on higher doses of Invega Sustenna, consider starting Caplyta slightly earlier (1-2 weeks before the next scheduled injection) to ensure adequate coverage 1, 3

Dosing Strategy

• Start with the standard recommended dose of Caplyta (42mg daily) 5
• No loading dose of Caplyta is required when switching from Invega Sustenna 4, 5
• Monitor closely for the first 4 weeks during the transition period 1

Monitoring Parameters

• Assess therapeutic response after at least 4 weeks on Caplyta 1
• Monitor for emergence of positive symptoms, which may indicate inadequate treatment coverage 1
• Watch for side effects specific to each medication during the transition 5

Special Considerations

Avoiding Pitfalls

• Be aware that the long half-life of paliperidone palmitate means it will remain in the system for weeks to months after the last injection 6, 2
• Avoid abrupt discontinuation of Invega Sustenna without implementing Caplyta, as this increases risk of relapse 1, 3
• Monitor for potential drug interactions, particularly those affecting metabolism 1

Patient-Specific Factors

• Consider renal function when switching, as paliperidone requires dose adjustment in renal impairment 3
• Evaluate metabolic parameters before and during the switch, as Caplyta may have a more favorable metabolic profile 5
• Ensure the patient understands the transition from a monthly injection to daily oral medication, as this may impact adherence 1

Clinical Decision-Making Algorithm

1. Confirm diagnosis and current symptom control on Invega Sustenna 1
2. Determine the timing of the last Invega Sustenna injection and when the next would be due 3
3. Begin Caplyta at the time of the next scheduled injection 3
4. Monitor closely for 4 weeks to ensure adequate symptom control 1
5. Assess for side effects and therapeutic response 5
6. Adjust Caplyta dosing if needed based on clinical response 5

Potential Benefits of Switching

• Caplyta may offer improved tolerability with lower rates of extrapyramidal symptoms and metabolic effects 5
• The switch eliminates the need for injections, which some patients may prefer 1
• Caplyta's novel mechanism may benefit patients who had partial response to Invega Sustenna 4, 5

Remember that antipsychotic switching should involve shared decision-making with the patient, considering both efficacy and side-effect profiles 1.