What is the recommended protocol for switching a patient from Abilify (Aripiprazole) to Latuda (Lurasidone) during inpatient acute care?

Switching from Abilify 15 mg to Latuda During Inpatient Acute Care

The recommended protocol for switching from Abilify (aripiprazole) 15 mg to Latuda (lurasidone) is a cross-titration approach over 1-2 weeks, with concurrent administration of both medications during the transition period.

Cross-Titration Protocol

Step 1: Initial Assessment (Day 1)

• Confirm current stable dose of Abilify 15 mg
• Assess baseline symptoms, vital signs, and metabolic parameters
• Order baseline labs: complete blood count, comprehensive metabolic panel, lipid profile

Step 2: Cross-Titration Schedule

• Days 1-3: Start Latuda 20 mg once daily with food (≥350 calories) while maintaining Abilify 15 mg
• Days 4-7: Increase Latuda to 40 mg once daily with food; reduce Abilify to 10 mg daily
• Days 8-10: Increase Latuda to 60 mg once daily with food (target dose); reduce Abilify to 5 mg daily
• Days 11-14: Continue Latuda 60 mg once daily with food; discontinue Abilify

Step 3: Monitoring During Transition

• Daily assessment of:
  • Mental status and psychiatric symptoms
  • Vital signs (particularly blood pressure)
  • Side effects (akathisia, sedation, extrapyramidal symptoms)
  • Sleep quality
  • Food intake (critical for Latuda absorption)

Important Clinical Considerations

Medication Administration

• Latuda requires administration with food (≥350 calories) for proper absorption
• Morning administration is preferred for Latuda to minimize sleep disturbances
• Ensure hospital meal timing aligns with medication administration

Dosing Rationale

• The initial Latuda dose of 20 mg allows for assessment of tolerability
• Target dose of Latuda 60 mg is appropriate for most patients switching from Abilify 15 mg
• The gradual taper of Abilify minimizes withdrawal effects and maintains symptom control

Potential Challenges

• Food requirement: Ensure patient is eating adequate calories with Latuda dose
• Akathisia: Monitor closely as this is a common side effect during transition
• Sedation differences: Latuda may cause more sedation than Abilify initially

Special Considerations for Inpatient Setting

• Utilize the inpatient setting to closely monitor the transition
• Document response to medication changes in daily progress notes
• Ensure nursing staff are aware of the food requirement for Latuda
• Consider benztropine or propranolol on an as-needed basis for potential extrapyramidal symptoms or akathisia

Discharge Planning

• Begin discharge planning early in the transition process
• Ensure patient has access to Latuda after discharge (prior authorization may be needed)
• Educate patient on the importance of taking Latuda with food
• Schedule follow-up appointment within 1-2 weeks of discharge

This cross-titration approach balances the need for maintaining symptom control while minimizing the risk of adverse effects during the transition from Abilify to Latuda in the inpatient setting.