From the Guidelines
When transitioning from aripiprazole to lurasidone, a cross-titration approach is generally recommended to minimize the risk of relapse and adverse effects. This approach involves continuing the current aripiprazole dose while starting lurasidone at 20-40 mg once daily with a meal of at least 350 calories, as noted in the context of antipsychotic management 1. The key considerations in this transition include:
- Gradually increasing the lurasidone dose over 1-2 weeks to the target dose (typically 40-80 mg daily for schizophrenia or 20-120 mg daily for bipolar depression)
- Simultaneously tapering the aripiprazole dose, for example, by reducing it by 5 mg every 3-7 days until discontinued completely 1
- Monitoring closely for withdrawal symptoms, rebound effects, or new side effects during this period, as switching from one antipsychotic to another can have varying outcomes, including the potential for treatment discontinuation or relapse 2 The entire transition typically takes 2-4 weeks depending on the starting aripiprazole dose. It's also important to note that patients should be advised that lurasidone must always be taken with food to ensure proper absorption, unlike aripiprazole which can be taken without regard to meals. The cross-titration method is preferred because these medications work on different receptor profiles - aripiprazole is a partial dopamine agonist while lurasidone is primarily a dopamine antagonist with additional serotonergic effects, which can influence the approach to transitioning between these medications 1. Given the potential for varying responses to antipsychotic therapy, including the possibility of adverse effects or reduced efficacy, careful consideration and monitoring are essential during the transition process, as highlighted by studies on antipsychotic polypharmacy and monotherapy 2, 1.
From the Research
Transitioning from Aripiprazole to Lurasidone
- The decision to transition from aripiprazole to lurasidone should be based on individual patient needs and medical history, as there is limited direct evidence comparing the two medications in the context of transitioning 3, 4.
- A study comparing the efficacy and acceptability of drug treatments for bipolar depression found that lurasidone was ranked second in terms of response, after olanzapine + fluoxetine, and had a lower risk of switch to mania compared to some other medications 4.
- Another study found that lurasidone was associated with less weight gain than olanzapine and quetiapine, and lower rates of somnolence than quetiapine and ziprasidone 5.
- When transitioning from aripiprazole to lurasidone, it is essential to consider potential drug interactions, particularly with antiepileptics, as some combinations may require dosing corrections or monitoring of medication levels 6.
- The efficacy and safety of lurasidone compared to other atypical antipsychotic monotherapies for bipolar depression have been evaluated in a systematic review and network meta-analysis, which found lurasidone to be more efficacious than aripiprazole and ziprasidone in some outcomes 5.
Key Considerations
- Patient factors, such as medical history, current medications, and individual response to treatment, should be taken into account when deciding to transition from aripiprazole to lurasidone 3, 4.
- Monitoring of medication levels, weight, and somnolence may be necessary when transitioning to lurasidone, particularly in combination with other medications 6, 5.
- Healthcare providers should be aware of the potential benefits and risks associated with lurasidone compared to other atypical antipsychotics, including aripiprazole, when making treatment decisions 4, 5.