How to switch from Abilify (aripiprazole) 10mg to Vraylar (cariprazine)?

Switching from Abilify 10mg to Vraylar (Cariprazine)

When switching from Abilify (aripiprazole) 10mg to Vraylar (cariprazine), a direct switch approach can be used with cariprazine initiated at 1.5mg daily while discontinuing aripiprazole, then titrating cariprazine to the target dose of 3-6mg over 1-2 weeks based on response and tolerability.

Rationale for Switching

• Both aripiprazole and cariprazine are atypical antipsychotics with partial agonist activity at dopamine D2 receptors, making a direct switch between them feasible without significant withdrawal concerns 1
• Switching between antipsychotics is indicated when there is inadequate response to the current medication or when patients experience intolerable side effects 1
• Cariprazine may provide benefits in patients who have not responded adequately to aripiprazole, as demonstrated in treatment-resistant depression cases where cariprazine augmentation was effective even after failure with aripiprazole 2

Recommended Switching Protocol

• Day 1-2: Start cariprazine at 1.5mg once daily while continuing aripiprazole 10mg 1
• Day 3-4: Continue cariprazine 1.5mg daily and reduce aripiprazole to 5mg daily 1
• Day 5-7: Discontinue aripiprazole completely and continue cariprazine 1.5mg daily 1
• Week 2: If tolerated, increase cariprazine to 3mg daily 1
• Week 3-4: Based on clinical response and tolerability, may further titrate cariprazine up to 4.5-6mg daily if needed 1

Monitoring During Transition

• Monitor for potential withdrawal symptoms or rebound effects during the cross-titration period 3
• Assess for extrapyramidal symptoms, akathisia, and other side effects that may occur during the transition 1
• Evaluate metabolic parameters (weight, lipid profile, glucose) at baseline and after the switch is complete, as cariprazine may have a different metabolic profile compared to aripiprazole 4
• Monitor for changes in efficacy during the transition period, as there may be a temporary worsening of symptoms during the switch 1

Special Considerations

• If the patient has been on aripiprazole for an extended period, a more gradual cross-titration may be preferred to minimize withdrawal symptoms 3
• Patients with hepatic impairment may require lower doses of cariprazine and a more cautious titration schedule 1
• The half-life of cariprazine and its active metabolites is longer than aripiprazole, which may affect the timing of full therapeutic effect and side effect manifestation 1

Potential Benefits of Switching

• Patients switched from other second-generation antipsychotics to aripiprazole have shown improvements in metabolic parameters, suggesting similar benefits might be observed with cariprazine 4
• Cariprazine has shown efficacy in treatment-resistant cases where other atypical antipsychotics have failed, indicating potential benefits for patients not responding adequately to aripiprazole 2

Common Pitfalls to Avoid

• Abrupt discontinuation of aripiprazole may lead to withdrawal symptoms or rebound effects; a gradual cross-titration is preferred 3
• Starting with too high a dose of cariprazine may increase the risk of side effects during the transition period 1
• Failure to monitor for drug interactions that may affect the metabolism of either medication during the transition 1
• Not allowing sufficient time for cariprazine to reach steady-state plasma levels before judging efficacy (may take 1-2 weeks) 1