Tapering Lurasidone 20mg
Yes, you should taper lurasidone 20mg gradually rather than stopping abruptly, even at this low dose, to minimize potential withdrawal symptoms and avoid rebound psychiatric symptoms.
Recommended Tapering Approach
A gradual taper over 2-4 weeks is recommended for lurasidone 20mg discontinuation. 1
Specific Tapering Schedule
- Week 1-2: Reduce to 10mg daily (50% reduction) 1
- Week 3-4: Reduce to 10mg every other day 1
- Final step: Discontinue completely after the every-other-day dosing period 1
If 10mg tablets are not available, you may need to work with your pharmacist to obtain appropriate dosing or extend the taper using alternate-day dosing with the 20mg tablet.
Why Tapering Matters
While lurasidone has a favorable metabolic and side effect profile compared to other antipsychotics 2, 3, 4, abrupt discontinuation of any antipsychotic can lead to:
- Withdrawal symptoms: anxiety, insomnia, irritability, nausea 1
- Rebound psychiatric symptoms: return or worsening of the condition for which lurasidone was prescribed 1
- Dopaminergic rebound: given lurasidone's D2 receptor antagonism 5
Monitoring During Taper
- Follow up at least once during the tapering period to assess for adverse effects 1
- Watch for withdrawal symptoms including anxiety, insomnia, irritability, gastrointestinal upset 1
- Monitor for psychiatric symptom recurrence (psychosis, mood instability, depending on indication) 1
If Withdrawal Symptoms Emerge
Slow the taper rate if clinically significant withdrawal symptoms develop. 1 This may involve:
- Extending each dose reduction phase to 2 weeks instead of 1 week 1
- Using smaller dose decrements if available 1
- Pausing the taper temporarily and restarting when symptoms resolve 1
Special Considerations
Given lurasidone's pharmacokinetics with an 18-hour half-life and requirement for administration with food 5, withdrawal symptoms may emerge 2-3 days after dose reduction or discontinuation. The relatively short half-life compared to some other antipsychotics makes gradual tapering particularly important 5.
Patient collaboration and understanding of the tapering plan is essential for successful discontinuation. 1 Ensure you understand what symptoms to watch for and when to contact your prescriber if concerning symptoms develop 1.