What are the considerations for switching from Quetiapine (Atypical Antipsychotic) to Aripiprazole (Atypical Antipsychotic)?

From the Guidelines

Switching from quetiapine to aripiprazole should be done with caution, as the evidence suggests that switching from antipsychotic polypharmacy to monotherapy can be associated with a significant risk of treatment discontinuation 1. When considering switching from quetiapine to aripiprazole, several factors should be taken into account, including the potential benefits and risks of the switch.

• The patient's current symptoms and response to quetiapine should be evaluated, as well as their medical history and any potential interactions with other medications.
• Aripiprazole has been shown to have a different side effect profile compared to quetiapine, with less sedation and metabolic issues, but potentially more activation symptoms such as akathisia 1.
• The switch should be done gradually through cross-titration, starting with a low dose of aripiprazole (typically 5-10 mg daily) while continuing the current quetiapine dose for 1-2 weeks, then gradually reducing quetiapine by 25-50 mg every 5-7 days while simultaneously increasing aripiprazole by 5 mg increments as needed 1.
• The entire transition typically takes 4-6 weeks, depending on the starting quetiapine dose, and should be done under medical supervision to monitor for potential side effects and adjust the schedule as needed.
• It is also important to note that some patients may not tolerate the switch to monotherapy, and may need to be returned to antipsychotic polypharmacy 1.
• A study found that almost 80% of patients with schizophrenia or schizoaffective disorder could safely switch from antipsychotic polypharmacy to monotherapy without indication of clinical worsening, but 20% could not 1.
• Another study found that patients who switched from antipsychotic polypharmacy to monotherapy experienced greater increases in symptoms and greater rates of discontinuation 1.
• The decision to switch from quetiapine to aripiprazole should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances, and should always be done under medical supervision 1.

From the FDA Drug Label

There are no systematically collected data to specifically address switching patients with schizophrenia from other antipsychotics to aripiprazole tablets or concerning concomitant administration with other antipsychotics While immediate discontinuation of the previous antipsychotic treatment may be acceptable for some patients with schizophrenia, more gradual discontinuation may be most appropriate for others. In all cases, the period of overlapping antipsychotic administration should be minimized.

The considerations for switching from Quetiapine to Aripiprazole include:

• No systematic data available to guide the switch
• Immediate discontinuation of the previous antipsychotic (Quetiapine) may be acceptable for some patients, but
• Gradual discontinuation may be more appropriate for others
• The period of overlapping administration should be minimized 2

From the Research

Considerations for Switching from Quetiapine to Aripiprazole

• The decision to switch from quetiapine to aripiprazole should be based on individual patient needs and preferences, as both strategies have been found to be safe and well-tolerated 3.
• When switching from quetiapine to aripiprazole, it is recommended to taper the quetiapine dose to minimize the risk of psychotic relapse or withdrawal symptoms 4.
• Aripiprazole can be initiated at a dose of 12 mg/d and titrated up to 30 mg/d, while the previous antipsychotic medication is reduced biweekly by 25% 3.
• The switching strategy should be individualized based on the patient's clinical response and tolerability, and should take into account the pharmacological characteristics of the previous antipsychotic agent 5.
• Studies have shown that switching from quetiapine to aripiprazole can be done safely and effectively, with minimal risk of adverse events or exacerbation of symptoms 6, 7.

Switching Strategies

• Immediate initiation of aripiprazole with simultaneous discontinuation of quetiapine
• Immediate initiation of aripiprazole while tapering off quetiapine over 2 weeks
• Up-titrating aripiprazole to 30 mg/d over 2 weeks, while simultaneously tapering off quetiapine
• Switching from oral quetiapine to long-acting injectable aripiprazole lauroxil has also been shown to be safe and effective 7

Patient Factors to Consider

• Clinical response to previous antipsychotic treatment
• Tolerability of previous antipsychotic treatment
• Patient preference for switching strategy
• Presence of comorbid medical or psychiatric conditions
• History of substance abuse or dependence 5