From the Research
The recommended protocol for switching from Abilify (aripiprazole) to Vraylar (cariprazine) typically involves a cross-titration approach, starting with adding Vraylar at 1.5 mg daily while continuing the current Abilify dose for about 1 week, as this method helps minimize withdrawal effects and maintains symptom control. This approach is based on the understanding that both medications work on similar dopamine and serotonin receptors, though with different binding profiles 1.
When initiating the switch, it's crucial to monitor for side effects like akathisia, insomnia, or digestive issues, as these can be indicative of the transition's tolerability. The overlap period, which allows Vraylar to reach steady-state levels before Abilify is fully discontinued, is key to maintaining therapeutic efficacy. According to pharmacokinetic data, aripiprazole reaches therapeutic concentrations within 7 days of initiation, but due to interpatient variability, a 14-day overlap is considered sufficient to ensure therapeutic concentrations are maintained 1.
The steps for the cross-titration include:
- Adding Vraylar at 1.5 mg daily while continuing the current Abilify dose for about 1 week.
- Increasing Vraylar to 3 mg daily while simultaneously reducing Abilify by 25-50% of the original dose.
- After another week, if tolerated, increasing Vraylar to the target dose (typically 3-6 mg daily) while further reducing Abilify.
- Finally, discontinuing Abilify completely while maintaining the therapeutic Vraylar dose.
This gradual transition is supported by studies indicating that aripiprazole and cariprazine have different pharmacological profiles but share some commonalities in their mechanism of action, which can facilitate a smoother transition 2, 3. However, it's essential to note that individual adjustments to this schedule may be needed based on symptom control and side effect profile, emphasizing the importance of close patient monitoring during the transition period.