How to discontinue Caplyta (lumateperone)?

How to Discontinue Caplyta (Lumateperone)

Caplyta (lumateperone) should be gradually tapered rather than abruptly discontinued to minimize withdrawal symptoms and ensure patient safety.

Recommended Tapering Protocol

• Initiate a slow, collaborative taper with the patient, explaining the process and setting realistic expectations 1
• Implement small dose decreases at first to address patient anxiety and increase confidence in the process 1
• For Caplyta 42 mg capsules, consider the following tapering schedule:
  • Weeks 1-2: 42 mg every other day (alternating days) 1, 2
  • Weeks 3-4: 42 mg every third day 1, 2
  • Weeks 5-6: Discontinue 1, 2
• Taper rate should be determined by the patient's ability to tolerate it; some patients may require a slower taper 1
• Close observation and support during the taper are critical to the process 1

Monitoring During Tapering

• Assess for withdrawal symptoms at each follow-up visit 1
• Monitor for clinical worsening, especially during the initial few months of dose changes 3
• Watch for both acute withdrawal symptoms and protracted withdrawal effects 1
• Pay attention to any emergence of suicidal thoughts or behaviors, which should be monitored closely during medication changes 3

Adjunctive Treatments During Tapering

• Consider non-pharmacological interventions to manage symptoms during taper:
  • Cognitive-behavioral therapy 1
  • Relaxation techniques 1
  • Regular physical activity 1
• Provide supportive care and reassurance that withdrawal symptoms, if they occur, are usually transient 4

Common Pitfalls to Avoid

• Avoid abrupt discontinuation, which increases risk of withdrawal symptoms 1
• Do not perform "cold referrals" to clinicians who have not agreed to accept the patient 1
• Avoid concurrent use of other CNS depressants during the taper period when possible 1
• Do not mistake withdrawal symptoms for relapse of the underlying condition 4

Special Considerations

• If severe withdrawal symptoms occur, consider reinstating the previous dose and slowing the rate of taper 4
• For patients with schizophrenia, monitor closely for return of psychotic symptoms 5, 6
• For patients taking Caplyta for bipolar depression, be particularly vigilant about mood changes during the tapering process 6

When to Seek Immediate Medical Attention

• If signs of Neuroleptic Malignant Syndrome appear (hyperpyrexia, muscle rigidity, delirium, autonomic instability), discontinue Caplyta immediately and provide intensive treatment 3
• If tardive dyskinesia develops or worsens during the tapering process, reevaluate the tapering schedule 3