Can I switch from Abilify (aripiprazole) to Seroquel (quetiapine)?

Switching from Abilify (Aripiprazole) to Seroquel (Quetiapine)

Yes, you can switch from Abilify to Seroquel, and the FDA label specifically addresses this transition, recommending that while immediate discontinuation of the previous antipsychotic may be acceptable for some patients, more gradual discontinuation may be most appropriate for others, with the period of overlapping antipsychotic administration minimized. 1

Switching Protocol

The most appropriate switching strategy depends on clinical circumstances and should follow a cross-titration approach:

Gradual Cross-Titration Method (Preferred)

• Start Seroquel at 25-50 mg/day while maintaining current Abilify dose 1
• Increase Seroquel by 25-50 mg increments daily toward target dose of 400-800 mg/day for schizophrenia 1
• Begin tapering Abilify gradually once Seroquel reaches 150-200 mg/day, as therapeutic coverage is established 2
• Complete the switch over 1-2 weeks, minimizing the overlap period while ensuring continuous antipsychotic coverage 1

Important Pharmacological Considerations

Aripiprazole has a very long half-life (75 hours), meaning it will remain in the system for weeks after discontinuation, providing some protection during the transition 2. This differs significantly from Seroquel's shorter half-life, which requires more frequent dosing.

Dosing Targets

For schizophrenia specifically:

• Seroquel target dose: 400-800 mg/day (maximum 800 mg/day) 1
• Elderly patients should start at 50 mg/day with 50 mg/day increments 1
• Hepatically impaired patients should start at 25 mg/day with 25 mg/day increments 1

Critical Monitoring During Transition

Assess Treatment Response Early

• Evaluate efficacy at 4 weeks on therapeutic Seroquel dose before concluding the switch was unsuccessful 2
• Monitor for worsening positive symptoms (delusions, hallucinations, agitation) during the transition period 2
• Reassess diagnosis and contributing factors if symptoms remain significant after adequate trial 2

Side Effect Profile Differences

The switch from Abilify to Seroquel involves important tolerability trade-offs:

• Seroquel is significantly more sedating than Abilify—warn patients about transient orthostasis and increased drowsiness 2
• Metabolic effects differ: Seroquel carries higher risk of weight gain and metabolic syndrome compared to Abilify's more favorable metabolic profile 2
• Extrapyramidal symptoms: Abilify (as a partial D2 agonist) may cause akathisia, while Seroquel has lower EPS risk but more sedation 2

Rationale for Switching

Valid reasons to switch from Abilify to Seroquel include:

• Inadequate control of positive symptoms after 4 weeks at therapeutic Abilify dose 2
• Intolerable akathisia or restlessness from Abilify's partial agonist activity 2
• Need for different pharmacodynamic profile—switching to an antagonist (Seroquel) from a partial agonist (Abilify) 2
• Insomnia requiring sedating properties that Seroquel provides 2

Common Pitfalls to Avoid

• Do not abruptly stop Abilify without starting Seroquel, as this creates a gap in antipsychotic coverage 1
• Do not use inadequate Seroquel doses—many patients require 400-800 mg/day for schizophrenia, not the lower doses used for other indications 1
• Do not overlook the need for EPS medication re-evaluation during and after the switch 1
• Do not switch if the patient has been stable on Abilify for years without compelling clinical reason, as unnecessary switches risk destabilization 2

Special Circumstances

If Patient Has Been Off Abilify >1 Week

• Follow initial Seroquel dosing schedule with gradual titration rather than jumping to maintenance dose 1

If Patient Has Been Off Abilify <1 Week

• May reinitiate at maintenance Seroquel dose without gradual escalation if clinically appropriate 1

Drug Interactions

• Reduce Seroquel to 1/6 original dose if co-administered with potent CYP3A4 inhibitors (ketoconazole, ritonavir) 1
• Increase Seroquel up to 5-fold if co-administered with CYP3A4 inducers (phenytoin, carbamazepine) for >7-14 days 1