Switching from Abilify (Aripiprazole) to Vraylar (Cariprazine)
Yes, you can switch from Abilify 10 mg to Vraylar, but a gradual cross-titration approach over 1-4 weeks is strongly recommended rather than abrupt discontinuation to prevent symptom worsening.
Rationale for Cross-Titration
Research evidence shows that abrupt discontinuation of aripiprazole can lead to an increase in symptom severity within the first week after switching 1. This is particularly important because:
- Both medications are atypical antipsychotics but have different receptor binding profiles
- Cross-titration helps maintain therapeutic blood levels during transition
- Gradual switching minimizes the risk of withdrawal symptoms or rebound effects
Recommended Switching Protocol
Week 1-2:
- Continue Abilify 10 mg daily
- Start Vraylar at 1.5 mg daily
Week 3:
- Reduce Abilify to 5 mg daily
- Increase Vraylar to 3 mg daily
Week 4:
- Discontinue Abilify completely
- Continue Vraylar at 3 mg daily (or adjust to 1.5-6 mg based on response and tolerability)
This approach is supported by evidence showing that a >1 to 4-week cross-titration period is better tolerated than a ≤1-week period, with lower rates of discontinuation due to adverse events (2.7% vs 10.4%) 2.
Monitoring During Transition
During the switching period, closely monitor for:
- Efficacy: Watch for any worsening of psychiatric symptoms
- Extrapyramidal symptoms (EPS): Both medications can cause EPS, but the risk may temporarily increase during transition
- Metabolic parameters: Both medications have different metabolic risk profiles
- Akathisia: This is a common side effect with both medications, particularly during dosage changes
Important Considerations
- Antipsychotic polypharmacy: Guidelines generally recommend antipsychotic monotherapy as the standard of care 3, but short-term overlap during cross-titration is an accepted practice
- Patient-specific factors: Adjust the titration schedule based on individual response, side effects, and comorbidities
- Documentation: Clearly document the rationale for switching and the cross-titration plan
Contraindications to Consider
- Known hypersensitivity to either medication
- Severe hepatic or renal impairment may require dosage adjustments
- Caution in patients with cardiovascular disease, as both medications can affect QTc interval
Follow-up Recommendations
Schedule follow-up within 1-2 weeks of initiating the switch to assess tolerability and efficacy of the transition. Continue regular monitoring throughout the cross-titration period.