Switching from Abilify 10mg to Seroquel: Protocol
When switching from Abilify (aripiprazole) 10mg to Seroquel (quetiapine), a gradual cross-titration approach over 1-2 weeks is recommended, starting with Seroquel 12.5mg twice daily while gradually reducing Abilify. 1
Recommended Cross-Titration Schedule
| Days | Abilify | Seroquel |
|---|---|---|
| 1-3 | 10mg | 12.5mg twice daily |
| 4-7 | 5mg | 25mg twice daily |
| 8-10 | 0mg | 50mg twice daily |
| 11-14 | 0mg | 100mg twice daily |
Rationale for Cross-Titration
- Aripiprazole has a long half-life (75 hours) and is a partial D2 receptor agonist
- Quetiapine has a shorter half-life (7 hours) and different receptor binding profile 2
- Gradual transition minimizes withdrawal effects and prevents rebound symptoms
- Cross-titration allows for adjustment to new side effect profile
Dosing Considerations for Quetiapine
- Initial dosage should be 12.5mg twice daily 3
- Target maintenance dose is typically 200mg twice daily 3
- Titration should be gradual to minimize side effects
- BID (twice daily) dosing is as effective as TID (three times daily) dosing 2
Monitoring During Transition
- Monitor closely for the first 24-48 hours after starting quetiapine for:
- Sedation (quetiapine is more sedating than aripiprazole)
- Orthostatic hypotension
- Transient dizziness
- Assess clinical response and side effects daily during the first week
Potential Side Effects to Monitor
- Quetiapine-specific side effects:
- Sedation/somnolence (more common than with aripiprazole)
- Orthostatic hypotension (especially during initial titration)
- Weight gain (though typically less than olanzapine)
- Transient dizziness
Special Considerations
- Administer quetiapine at bedtime if sedation is problematic
- If switching due to extrapyramidal symptoms (EPS) from Abilify, note that quetiapine has lower risk of EPS 3
- Quetiapine has minimal impact on prolactin levels 2
- Consider monitoring metabolic parameters (weight, blood glucose, lipids) before and during treatment
Cautions
- Avoid abrupt discontinuation of aripiprazole to prevent withdrawal symptoms
- Use caution when combining quetiapine with other CNS depressants
- Beware of transient orthostasis during initial titration 3
- Adjust schedule for elderly patients or those with hepatic impairment (use lower doses)
This cross-titration approach balances the need to maintain symptom control while minimizing side effects during the transition from Abilify to Seroquel.