Switching from Abilify 15 mg to Latuda: Dosing and Tapering Schedule
When switching from Abilify (aripiprazole) 15 mg to Latuda (lurasidone), the recommended approach is to start Latuda at 20 mg once daily with food (at least 350 calories) while cross-tapering Abilify by reducing it by 5 mg every 1-2 weeks until discontinuation. 1
Initial Assessment and Planning
Before initiating the switch:
- Verify current psychiatric stability
- Ensure no contraindications to Latuda (hypersensitivity, concurrent strong CYP3A4 inhibitors or inducers)
- Plan for the switch during a period of relative clinical stability
Cross-Tapering Schedule
Week 1:
- Continue Abilify 15 mg daily
- Start Latuda 20 mg once daily with food (≥350 calories)
Week 2:
- Reduce Abilify to 10 mg daily
- Continue Latuda 20 mg once daily with food
Week 3-4:
- Reduce Abilify to 5 mg daily
- Continue Latuda 20 mg once daily with food
- Assess for efficacy and tolerability
Week 5:
- Discontinue Abilify completely
- Continue Latuda 20 mg once daily with food
Latuda Dosing Considerations
- Starting dose: 20 mg once daily 1
- Effective dose range: 20-120 mg daily for adults 1
- Most patients respond to 20-60 mg daily 1
- Maximum recommended dose: 120 mg daily 1
- Dose adjustments should be made based on clinical response and tolerability
Critical Administration Requirements
- Latuda must be taken with food (at least 350 calories) 1
- Food increases Latuda absorption substantially:
- AUC increases approximately 2-fold
- Cmax increases approximately 3-fold
Monitoring During Transition
Monitor for:
- Withdrawal symptoms from Abilify
- Emergence of new side effects from Latuda
- Changes in psychiatric symptoms
- Sleep disturbances
- Extrapyramidal symptoms
Special Considerations
Dose Adjustments for Medical Conditions
- Renal impairment: For moderate to severe renal impairment, start Latuda at 20 mg daily, maximum 80 mg daily 1
- Hepatic impairment:
- Moderate impairment: Start at 20 mg daily, maximum 80 mg daily
- Severe impairment: Start at 20 mg daily, maximum 40 mg daily 1
Drug Interactions
- Avoid strong CYP3A4 inhibitors (ketoconazole, clarithromycin, etc.) 1
- With moderate CYP3A4 inhibitors, reduce Latuda dose by half 1
- Avoid grapefruit and grapefruit juice 1
- Avoid strong CYP3A4 inducers (rifampin, St. John's wort, etc.) 1
Potential Challenges and Management
Managing Withdrawal Symptoms
If withdrawal symptoms occur during Abilify tapering:
- Slow down the taper (reduce by smaller increments)
- Extend the time between dose reductions
- Consider temporary return to previous dose if symptoms are severe
Managing Side Effects of Latuda
- Akathisia/restlessness: Consider propranolol if needed 2
- Nausea: Ensure medication is taken with adequate food
- Somnolence: Consider taking Latuda in the evening
Follow-up Recommendations
- Weekly follow-up during the cross-tapering period
- Assess efficacy, tolerability, and adherence
- After stabilization on Latuda monotherapy, follow-up can be less frequent
This cross-tapering approach minimizes the risk of withdrawal symptoms while ensuring adequate therapeutic coverage during the transition period.