What is the recommended schedule to switch from Abilify (aripiprazole) 10mg to lurasidone?

Switching from Aripiprazole 10mg to Lurasidone

Recommended Cross-Taper Strategy

Start lurasidone at 40mg daily with food while simultaneously beginning a gradual taper of aripiprazole 10mg, reducing it by 50% (to 5mg) during week 1, then discontinuing by the end of week 2. 1, 2

Detailed Week-by-Week Protocol

Week 1

• Start lurasidone 40mg once daily with food (lurasidone requires food intake for proper absorption) 3, 2
• Reduce aripiprazole from 10mg to 5mg daily 1, 2
• This simultaneous approach is supported by evidence showing comparable safety and tolerability to delayed tapering strategies 4

Week 2

• Continue lurasidone 40mg daily with food 2
• Discontinue aripiprazole completely by end of week 2 1, 2

Weeks 3-6

• Flexibly adjust lurasidone dose between 40-120mg daily based on clinical response and tolerability 2
• Consider increasing to 80mg daily if 40mg provides insufficient symptom control 2
• The therapeutic range for lurasidone in schizophrenia and bipolar depression is 20-120mg daily 3, 5

Critical Administration Requirements

• Lurasidone must be taken with food (at least 350 calories) to ensure adequate absorption 3
• Failure to take with food significantly reduces bioavailability and therapeutic efficacy 1

Expected Side Effects and Management

Most Common Side Effects

• Nausea, somnolence, and akathisia are the most frequently reported adverse events during lurasidone initiation 3, 2, 5
• Akathisia occurs in approximately 12.5% of patients but rarely leads to discontinuation (0.4%) 2
• Gastrointestinal symptoms (nausea, vomiting) typically emerge early but often resolve with continued treatment 3, 5

Metabolic Advantages

• Lurasidone demonstrates minimal effects on weight, glucose, lipids, and prolactin compared to many other antipsychotics 3, 2, 5
• Mean improvements in weight and lipid parameters have been observed during lurasidone treatment 2

Monitoring and Assessment

Early Assessment (Weeks 1-4)

• Evaluate treatment response and tolerability at week 4 to determine if dose adjustment is needed 1, 2
• Monitor for akathisia, sedation, and gastrointestinal symptoms 2, 5

Ongoing Monitoring

• Assess positive symptoms, mood symptoms, and functional status regularly 1
• Movement disorder screening should be performed, though lurasidone shows low risk for extrapyramidal symptoms 2

Important Clinical Considerations

Pharmacological Rationale

• Switching from a D2 partial agonist (aripiprazole) to a D2 antagonist (lurasidone) represents a change in pharmacodynamic profile, which is appropriate when first-line treatment is inadequate 1
• This switch aligns with guideline recommendations to try agents with different receptor profiles when initial treatment fails 1

Treatment Failure Definition

• If significant symptoms persist after 4 weeks at therapeutic lurasidone doses with confirmed adherence, reassess diagnosis and consider alternative strategies 1
• Treatment failure rates during switching to lurasidone are low (7.9% overall) 2

Special Populations

• Patients previously on sedating antipsychotics may experience slightly higher treatment failure rates (11.6%) compared to those on non-sedating agents (5.8%) 2
• The simultaneous taper approach has been validated as safe and well-tolerated across diverse patient populations 4

Alternative Dosing Strategy

For patients particularly sensitive to medication changes or with high anxiety about switching, consider starting lurasidone at 40mg for one week, then increasing to 80mg in week 2 while tapering aripiprazole 2. However, the standard simultaneous approach described above is equally effective and completes the switch more efficiently 2, 4.