Switching from Aripiprazole 10mg to Lurasidone
Start lurasidone at 40 mg once daily with food (at least 350 calories) while simultaneously tapering aripiprazole to 50% of the original dose (5 mg) by day 7, then discontinuing aripiprazole completely by the end of week 2. 1, 2
Switching Protocol
Week 1
- Day 1: Start lurasidone 40 mg once daily with food (minimum 350 calories required for optimal absorption) 1, 3
- Days 1-7: Continue aripiprazole 10 mg daily alongside lurasidone 2
- Day 7: Reduce aripiprazole to 5 mg (50% of original dose) 2
Week 2
- Continue lurasidone 40 mg once daily with food 2
- Continue aripiprazole 5 mg through week 2 2
- End of Week 2: Discontinue aripiprazole completely 2
Weeks 3-6
- Continue lurasidone 40 mg once daily, or increase to 80 mg if clinically indicated after week 2 2
- Flexible dosing between 40-120 mg/day is appropriate based on clinical response 1, 2
Dosing Considerations
No initial titration of lurasidone is required—the recommended starting dose is 40 mg once daily. 1, 3 The maximum recommended dose is 160 mg/day, though doses above 80 mg/day may not confer additional benefit and can increase adverse effects like somnolence and akathisia. 1, 3
Food requirement is critical: Lurasidone must be taken with at least 350 calories to achieve adequate absorption—administration with food increases AUC approximately 2-fold and Cmax approximately 3-fold. 1
Alternative Switching Strategies
Based on a randomized switching study, three approaches were equally effective: 2
- 40 mg/day for 2 weeks (then flexible dosing)
- 40 mg/day for week 1, then 80 mg/day for week 2 (then flexible dosing)
- 80 mg/day for 2 weeks (then flexible dosing)
The first approach (40 mg for 2 weeks) is recommended as the safest starting point, particularly given aripiprazole's partial D2 agonist properties versus lurasidone's full D2 antagonist profile. 2
Monitoring and Expected Outcomes
Treatment failure rates are low (7.9% in switching studies), with most failures occurring within the first 2 months. 2 The median time to treatment failure was 58 days in extension studies. 4
Common adverse effects during the switch include: 4, 2
- Akathisia (12.5% incidence, though only 0.4% discontinue due to this)
- Insomnia (8.8%)
- Nausea (8.8%)
- Somnolence
Metabolic advantages: Unlike many antipsychotics, lurasidone shows minimal weight gain and no clinically meaningful changes in glucose, lipids, insulin, or prolactin—mean improvements in weight and lipids are often observed. 4, 2
Important Drug Interactions
Contraindicated: Do not use lurasidone with strong CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir). 1
Dose reduction required: If moderate CYP3A4 inhibitors (diltiazem, erythromycin, fluconazole) are used, reduce lurasidone dose to half the original level. 1
Avoid: Strong CYP3A4 inducers (rifampin, carbamazepine) are contraindicated as they significantly reduce lurasidone efficacy. 1, 3
Special Populations
Renal impairment: Start at 20 mg/day; maximum 80 mg/day for moderate-to-severe impairment (CrCl <50 mL/min). 1
Hepatic impairment: Start at 20 mg/day; maximum 80 mg/day for moderate impairment, 40 mg/day for severe impairment. 1
Elderly or frail patients: Consider starting at lower doses and monitoring closely for orthostatic effects and movement disorders. 5