Combining Abilify (Aripiprazole) and Latuda (Lurasidone)
Combining Abilify and Latuda is generally not recommended, as major clinical guidelines advise against routine antipsychotic polypharmacy due to increased side effects without proven additional benefit, and this specific combination lacks supporting evidence for safety or efficacy. 1
Guideline Recommendations on Antipsychotic Polypharmacy
The National Institute for Health and Care Excellence (NICE) explicitly advises against regular combined antipsychotic medication except for short periods during medication transitions. 1
The World Federation of Societies of Biological Psychiatry only recommends considering antipsychotic polypharmacy in specific cases like treatment-resistant schizophrenia. 1
The American Psychiatric Association guidelines endorse monotherapy and do not acknowledge situations where routine antipsychotic polypharmacy would be recommended. 1
Specific Risks of This Combination
Both aripiprazole and lurasidone work through dopamine receptor modulation, creating potential for additive adverse effects on the dopaminergic system. 1
This combination may lead to increased extrapyramidal symptoms (EPS) due to additive effects on dopamine receptors. 1
The combination increases the global side-effect burden, including higher risk of Parkinsonian side effects. 1
Potential cognitive impairment may occur, though this may relate to higher total antipsychotic dosing rather than polypharmacy itself. 1
When Combination Therapy Might Be Considered
The only scenarios where antipsychotic combinations have guideline support are:
Treatment-resistant schizophrenia where clozapine monotherapy has failed - even then, adding a second antipsychotic is only considered, not routinely recommended. 1
During cross-titration periods when switching from one antipsychotic to another - this should be time-limited. 1
Managing specific medication side effects (e.g., adding aripiprazole to counteract metabolic or prolactin-related side effects of other antipsychotics). 1
Preferred Alternative Approaches
If monotherapy with either aripiprazole or lurasidone is ineffective, optimize the dose of the single agent before considering any combination. 1
For bipolar disorder specifically, aripiprazole combined with mood stabilizers (lithium, valproate, or lamotrigine) has demonstrated efficacy and safety in controlled trials. 2, 3, 4, 5
Lurasidone combined with lithium or valproate has proven efficacy for bipolar depression and maintenance treatment. 4
If Polypharmacy Is Deemed Absolutely Necessary
Select antipsychotics with differing side-effect profiles to minimize additive adverse effects. 1
Monitor closely for extrapyramidal symptoms, metabolic effects, and drug-drug interactions affecting plasma concentrations. 1
Avoid combining two drugs from the same class or with similar mechanisms of action. 6