Cross tapering

[Kuvan]

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Does anyone know how to cross taper Thorazine to Latuda? Thanks,

 

[NickNaylor]

What do you mean "how?" As far as I'm aware there are no specific algorithms or processes to do these cross-tapers, and it's very much a trial-and-error process. Start lurasidone at the lowest dose possible, make sure it's tolerated, and increase the dose while decreasing the chlorpromazine. Depending on the dose of chlorpromazine, you may have to decrease that more rapidly than you increase the lurasidone since it's a relatively low potency antipsychotic agent.

 

[whopper]

Nick's right. This isn't an exact type of thing especially cause there's several factors at play here that we cannot predict without actually doing it. E.g. the new med might not work at all or otherwise not as expected for various reasons that we can't predict until it's done. E.g. the Latuda binds different receptors and differentials not the same with Thorazine, the patient's metabolism of the meds etc.

The only medication coming to mind where you can easily cross-titrate in a very predictable manner is Escitalopram to Citalopram because the active medication is the same exact thing.

Even when converting an IR med to an ER med of the otherwise same exact med problems could occur. E.g. Adderall ER to IR the patient might c/o of a "crashing feeling," or when doing IR to ER they might state they feel the effect longer but it's never strong enough to treat their problem.

In outpatient, for psychosis, I cross-taper very very slowly. E.g. like up to 20% of the medication dosage a month at the fastest. Reason why is cause if it won't work well you'll be able to catch it before things get real real bad (e.g. full decompensation requiring hospitalization). If inpatient, I might do it faster. E.g. up to 20% change of dosage every 1-5 days.

 

[Kuvan]

Thank you very much! 🙂

 

[Kuvan]

What do you mean "how?" As far as I'm aware there are no specific algorithms or processes to do these cross-tapers, and it's very much a trial-and-error process. Start lurasidone at the lowest dose possible, make sure it's tolerated, and increase the dose while decreasing the chlorpromazine. Depending on the dose of chlorpromazine, you may have to decrease that more rapidly than you increase the lurasidone since it's a relatively low potency antipsychotic agent.

I agree. It depends on how the pt is responding the the new med and if he's having cholinergic rebound from chlorpromazine. In your answer, you said to decrease chlorpromazine more rapidly since it's a low potency antipsychotic. I thought that if it's low potency, it will have anticholinergic, antihistaminergic, and alpha-1 blocking properties. Wouldn't it be wise to taper slowly to avoid cholinergic rebound?

 

[Kuvan]

Nick's right. This isn't an exact type of thing especially cause there's several factors at play here that we cannot predict without actually doing it. E.g. the new med might not work at all or otherwise not as expected for various reasons that we can't predict until it's done. E.g. the Latuda binds different receptors and differentials not the same with Thorazine, the patient's metabolism of the meds etc.

The only medication coming to mind where you can easily cross-titrate in a very predictable manner is Escitalopram to Citalopram because the active medication is the same exact thing.

Even when converting an IR med to an ER med of the otherwise same exact med problems could occur. E.g. Adderall ER to IR the patient might c/o of a "crashing feeling," or when doing IR to ER they might state they feel the effect longer but it's never strong enough to treat their problem.

In outpatient, for psychosis, I cross-taper very very slowly. E.g. like up to 20% of the medication dosage a month at the fastest. Reason why is cause if it won't work well you'll be able to catch it before things get real real bad (e.g. full decompensation requiring hospitalization). If inpatient, I might do it faster. E.g. up to 20% change of dosage every 1-5 days.

In this case, pt said he was doing quite well while he was on Latuda. He was admitted recently and was put on Chlorpromazine. In the process of switching him back to Latuda.

 

[clozareal]

Antipsychotic Dose Conversion Calculator

Cross-taper from lurasidone 80mg to chlorpromazine

Days	lurasidone	chlorpromazine
1-3	60 mg	100 mg
4-6	40 mg	200 mg
7-9	20 mg	300 mg
10-	0 mg	400 mg

 

[Mass Effect]

In outpatient, for psychosis, I cross-taper very very slowly. E.g. like up to 20% of the medication dosage a month at the fastest. Reason why is cause if it won't work well you'll be able to catch it before things get real real bad (e.g. full decompensation requiring hospitalization). If inpatient, I might do it faster. E.g. up to 20% change of dosage every 1-5 days.

I'm used to inpatient so I tend to do this relatively quickly, but question for you. When you say you do up to 20% a month, do you mean you decrease the Thorazine dose by 20% per month or that you increase the Latuda dose by 20% per month or both? Also, how often do you see these patients while you're doing this so you can catch the earliest signs of decomp?