How to safely discontinue Latuda (lurasidone) 120 mg?

How to Discontinue Latuda 120 mg

Latuda (lurasidone) should be tapered gradually rather than stopped abruptly, though specific tapering protocols for antipsychotics are not well-established in the literature—a gradual dose reduction of approximately 10% per month with close monitoring for withdrawal symptoms and psychiatric destabilization is the safest approach based on principles from other psychotropic medication discontinuation. 1, 2

Key Considerations Before Starting the Taper

The FDA label for lurasidone does not provide specific discontinuation guidance, but warns that antipsychotic treatment withdrawal can unmask underlying tardive dyskinesia and may lead to psychiatric destabilization. 3

Before initiating discontinuation, evaluate for:

• Current psychiatric stability (depression, anxiety, psychosis symptoms) as these conditions should be addressed to improve taper outcomes 1
• Patient motivation and readiness for tapering, as patient agreement is a key component of successful tapers 1
• Review the original indication for Latuda and ensure alternative treatment strategies are in place if needed 1
• History of relapse with prior medication discontinuation attempts 3

Recommended Tapering Protocol

For patients on Latuda 120 mg long-term (≥1 year), reduce by approximately 10% per month or slower rather than more rapid tapers. 1, 2

Specific Dosing Schedule:

• Month 1: Reduce to 108 mg daily (90% of 120 mg) 1
• Month 2: Reduce to 97.2 mg daily (90% of 108 mg) - round to nearest available dose 1
• Month 3: Reduce to 87.5 mg daily (90% of 97.2 mg) 1
• Continue this pattern: Each new dose should be 90% of the previous dose, not a straight-line reduction from the starting dose 1, 2

Important: Lurasidone must be taken with food (at least 350 calories) as food significantly increases absorption. 4, 5 Maintain this requirement throughout the taper.

Slower Tapers May Be Necessary

• For patients on Latuda for multiple years or at higher doses, consider 5% monthly reductions instead of 10% 1
• Longer duration of previous antipsychotic therapy requires a longer taper—tapers can extend over several months to years depending on individual response 2

Monitoring During the Taper

Follow up at least monthly with patients during the tapering process. 1

Watch for:

• Withdrawal symptoms: Insomnia, anxiety, irritability, dysphoria, agitation 1, 6
• Psychiatric destabilization: Worsening psychosis, mood symptoms, or return of original symptoms 1, 3
• Extrapyramidal symptoms: Tardive dyskinesia may become unmasked when antipsychotic treatment is withdrawn 3
• Akathisia and parkinsonism: These are common with lurasidone and may worsen during taper 4, 5

If clinically significant withdrawal or psychiatric symptoms emerge, slow the taper rate further or pause the taper. 1, 2

Managing Withdrawal and Destabilization

Withdrawal distress should be preempted and managed with adjuvant medications for specific symptoms such as anxiety and insomnia. 7, 2

If significant symptoms develop:

• Slow the taper rate further or pause completely 1, 2
• Consider returning to the previous stable dose and then tapering even more slowly 6
• Maximize non-pharmacologic treatments including cognitive behavioral therapy and psychosocial support 7, 1
• Provide frequent support through telephone contact, telehealth visits, or face-to-face visits 1

Special Considerations

• Tapers may need to be paused and restarted when the patient is ready, particularly as patients reach lower doses 1
• The target dose may not be zero—some patients may benefit from maintenance at a lower dose rather than complete discontinuation 1, 2
• Before reversing a taper, carefully assess and discuss with the patient the benefits and risks of increasing lurasidone dosage 1, 2
• Collaborate with the patient on the tapering plan, including how quickly tapering will occur and when pauses might be warranted 1
• Set realistic expectations at the start regarding individualized goals, patient fears, and contingency plans should problems arise 1

Common Pitfalls to Avoid

• Never abruptly discontinue Latuda except in cases of severe medical emergency (such as neuroleptic malignant syndrome), as this can precipitate rapid psychiatric destabilization 1, 2, 3
• Do not use a straight-line taper that would subject patients to increasingly large absolute dose reductions as they approach zero 1, 2
• Do not mandate zero as the target dose for all patients—some may require long-term low-dose maintenance 1, 2
• Do not taper faster than 10% per month for long-term users, as this increases risk of withdrawal and psychiatric relapse 1, 2
• Avoid "cold referrals" to other clinicians who have not agreed to accept the patient during taper 7, 2
• Do not confuse withdrawal symptoms with relapse of the underlying psychiatric condition—withdrawal symptoms (such as anxiety, insomnia, irritability) may mimic psychiatric symptoms 7, 8, 6