Transitioning from Abilify (Aripiprazole) to Lurasidone
Start lurasidone at 40 mg once daily with food while simultaneously tapering aripiprazole by 50% on day 1, then discontinue aripiprazole completely by day 7-14. 1
Recommended Cross-Taper Schedule
Week 1-2: Initiation Phase
- Day 1: Start lurasidone 40 mg once daily with at least 350 calories of food (required for optimal bioavailability), while reducing aripiprazole to 50% of current dose 2, 1
- Day 7-14: Discontinue aripiprazole completely while continuing lurasidone 40 mg daily 1
- No initial dose titration is required for lurasidone - the 40 mg starting dose is therapeutic 3, 2
Week 3-6: Dose Optimization Phase
- After aripiprazole is fully discontinued, lurasidone can be flexibly dosed between 40-120 mg/day based on clinical response 1
- If dose increase is needed, consider either:
- Maximum recommended dose is 80 mg/day for schizophrenia, though doses up to 160 mg/day are FDA-approved 3, 2
Critical Administration Requirements
Lurasidone must be taken with at least 350 calories of food to ensure adequate absorption - this is non-negotiable for therapeutic efficacy 2
Evidence Supporting This Approach
The cross-taper strategy is based on a randomized, open-label switch study of 240 patients with schizophrenia or schizoaffective disorder, which demonstrated that switching to lurasidone can be successfully accomplished by starting at 40 mg/day while tapering the previous antipsychotic to 50% by day 7 and discontinuing by week 2 1. Treatment failure rates were low (7.9%), supporting the safety of this approach 1.
Monitoring Considerations
Expected Tolerability Profile
- Most common adverse events: Akathisia (12.5%), somnolence, nausea, and parkinsonism 3, 1
- Metabolic advantages: Minimal weight gain, no clinically meaningful changes in glucose, lipids, or QTc interval 3, 2, 1
- Only 0.4% discontinued due to akathisia in the switch study 1
Special Populations
- Elderly/frail patients: Consider slower taper and lower starting doses, though specific guidance is limited in available evidence 4
- Hepatic metabolism: Lurasidone is metabolized via CYP3A4 - avoid concurrent use with strong CYP3A4 inhibitors (ketoconazole) or inducers (rifampin) 2
Common Pitfalls to Avoid
- Do not administer lurasidone without food - bioavailability is significantly reduced on an empty stomach 2
- Do not exceed 80 mg/day without clear clinical justification - doses above 80 mg do not confer added benefit and increase risk of somnolence and akathisia 2
- Do not taper aripiprazole too slowly - the 2-week discontinuation window is evidence-based and prevents prolonged polypharmacy 1