What is the recommended dosing when switching from Latuda (lurasidone) to Caplyta (lumateperone)?

Switching from Latuda (Lurasidone) to Caplyta (Lumateperone)

When switching from Latuda to Caplyta, initiate Caplyta at 42 mg once daily with food while simultaneously discontinuing Latuda—no cross-titration or washout period is required due to both medications' similar receptor profiles and relatively short half-lives.

Dosing Strategy

Caplyta Initiation

• Start Caplyta at 42 mg once daily taken with food 1, 2
• This is the standard therapeutic dose; no titration is necessary 1, 2
• Must be taken with food (at least 350 calories) to ensure adequate absorption 2

Latuda Discontinuation

• Discontinue Latuda on the same day you start Caplyta 3
• No tapering of Latuda is required when switching to another antipsychotic 3
• Latuda's half-life is approximately 18 hours, allowing for direct switching 3, 4

Rationale for Direct Switch

Pharmacological Compatibility

• Both medications are atypical antipsychotics with serotonin 2A (5-HT2A) and dopamine D2 receptor antagonism 1, 3, 2
• Lumateperone has additional glutamatergic modulation (NMDA and AMPA receptors) not present in lurasidone 2, 5
• The overlapping receptor profiles minimize risk of withdrawal symptoms or psychotic symptom exacerbation 1, 2

Safety Considerations

• No washout period is needed because both drugs have relatively short half-lives and similar mechanisms of action 3, 2
• Cross-titration is unnecessary and may expose patients to excessive dopamine blockade 1, 2

Expected Clinical Changes

Symptom Management

• Caplyta demonstrates efficacy across positive symptoms, negative symptoms, and cognitive dysfunction in schizophrenia 1, 2
• Patients may experience improvements in social function and depressive symptoms that may not have been adequately addressed by Latuda 2

Side Effect Profile Differences

• Caplyta has lower risk of extrapyramidal symptoms (EPS) compared to Latuda 1, 2
• Lurasidone carries higher risk of akathisia than other modern antipsychotics 3
• Most common adverse effects with Caplyta are sedation (24.1%), dry mouth (5%), somnolence, and fatigue 1, 2
• Caplyta is associated with weight decrease rather than weight gain, unlike many antipsychotics 1
• Metabolic parameters (BMI, lipids, glucose, prolactin) typically improve with Caplyta 1

Monitoring Protocol

First 4-6 Weeks

• Monitor for sedation and somnolence, which are most common in the initial treatment period 1, 2
• Assess for any emergence of psychotic symptoms during the transition 2
• Evaluate for akathisia resolution if this was present on Latuda 1, 3

Ongoing Monitoring

• Track weight, BMI, and metabolic parameters—expect improvement rather than deterioration 1
• Monitor for constipation, diarrhea, and dry mouth as these occur in ≥5% of patients 1
• Assess efficacy on positive, negative, and cognitive symptoms 1, 2

Common Pitfalls to Avoid

• Do not attempt cross-titration (overlapping both medications)—this increases side effect burden without clinical benefit 1, 2
• Do not forget food requirement—Caplyta must be taken with at least 350 calories for proper absorption 2
• Do not assume similar dosing equivalence—Latuda doses range from 40-160 mg while Caplyta has a fixed 42 mg dose 1, 3, 2
• Do not overlook the metabolic benefits—patients switching from Latuda may experience weight loss and improved metabolic parameters on Caplyta 1