How to transition from Abilify (Aripiprazole) 5mg to Lurasidone?

Transitioning from Aripiprazole 5mg to Lurasidone

Start lurasidone at 40 mg once daily with food while simultaneously tapering aripiprazole over 1-2 weeks, then discontinue aripiprazole completely. This cross-titration approach minimizes the risk of symptom exacerbation while allowing for adequate monitoring of tolerability during the switch.

Recommended Transition Strategy

Initial Lurasidone Dosing

• Begin lurasidone at 40 mg once daily, taken with food (at least 350 calories) 1, 2, 3
• No initial dose titration is required for lurasidone 1, 3
• Food administration is mandatory as it significantly increases lurasidone absorption 1, 2

Aripiprazole Taper Schedule

Based on evidence from antipsychotic switching studies, the following approach is recommended 4:

• Week 1: Start lurasidone 40 mg daily + reduce aripiprazole to 2.5 mg (50% of original dose)
• Week 2: Continue lurasidone 40 mg daily + discontinue aripiprazole completely by end of week 2
• Weeks 3-6: Maintain or adjust lurasidone dose (40-120 mg range) based on clinical response 4

This gradual cross-titration over 2 weeks allows the previous antipsychotic to be tapered while establishing therapeutic levels of the new medication 4.

Dosing Flexibility After Initial Switch

After the initial 2-week transition period, lurasidone can be flexibly dosed between 40-160 mg once daily 1, 2. The FDA-approved dose range is 40-160 mg/day, though most clinical trials used 40-120 mg/day 1, 4.

If additional efficacy is needed after stabilization:

• Increase to 80 mg/day after week 2-3 if response is inadequate 4
• Further titration to 120-160 mg/day can be considered based on tolerability and clinical need 1, 2

Monitoring During Transition

Expected Side Effects

The most common adverse events with lurasidone that require monitoring include 1, 2, 3:

• Akathisia (12.5% incidence): Monitor closely, especially in first 2-4 weeks; manageable with dose adjustment or adjunctive treatment 2, 4
• Somnolence: Usually transitory and improves over time 2, 3
• Nausea and GI upset: Typically mild and self-limiting 1, 5, 3
• Parkinsonism: Rare and mild compared to other antipsychotics 5, 3

Metabolic Advantages

Lurasidone demonstrates minimal metabolic effects, making it particularly advantageous for patients with metabolic concerns 2, 3, 4:

• Minimal to no weight gain (often weight reduction observed) 2, 3, 4
• No clinically significant changes in glucose, lipids, or insulin 3, 4
• Mean improvements in weight and lipids have been documented during switches 4
• Minimal prolactin elevation 5, 3

Clinical Considerations

Why This Approach Works

A randomized 6-week study specifically examined switching strategies to lurasidone and found that starting at either 40 mg/day or 80 mg/day for 2 weeks while tapering the previous antipsychotic was effective, with treatment failure rates of only 7.9% 4. The study demonstrated that no initial titration is necessary, and the previous antipsychotic can be safely discontinued by week 2 4.

Special Populations

• Patients switching from sedating antipsychotics (like olanzapine or quetiapine) may experience slightly higher treatment failure rates (11.6% vs 5.8%) but overall success remains high 4
• Since aripiprazole is considered "nonsedating," the transition should be relatively straightforward 4

Common Pitfalls to Avoid

• Do not forget food requirement: Lurasidone must be taken with at least 350 calories to ensure adequate absorption 1, 2
• Do not taper too quickly: Abrupt discontinuation of aripiprazole may cause withdrawal symptoms or symptom exacerbation 4
• Do not over-titrate initially: Starting at 40 mg is sufficient; premature dose escalation increases side effect risk without proven benefit 1, 4

When to Adjust the Plan

If akathisia emerges and is intolerable, consider 2:

• Dose reduction (back to 40 mg if increased)
• Adjunctive beta-blocker or benzodiazepine
• Slower aripiprazole taper if symptoms emerged during transition

Only 0.4% of patients discontinued lurasidone due to akathisia in switching studies, indicating this side effect is generally manageable 4.