From the Guidelines
Switching from Vraylar to Abilify should be considered due to Abilify's more favorable weight-neutral profile, as evidenced by studies showing aripiprazole generally demonstrates a lower risk for weight gain 1. When making this switch, it's crucial to do so under medical supervision, as both are atypical antipsychotics with similar mechanisms but different properties. The transition typically involves a cross-titration approach where Abilify is gradually introduced while Vraylar is tapered down. Key points to consider during this transition include:
- Starting Abilify at a dose of 5-10 mg daily while reducing Vraylar by 50% for about a week,
- Then completely discontinuing Vraylar while continuing Abilify at the target dose, usually 10-15 mg daily for most conditions. This gradual transition helps minimize withdrawal effects and maintains symptom control. Patients should be monitored for side effects during the switch, including insomnia, headache, or anxiety. The decision to switch is often based on differences in side effect profiles, tolerability, or cost advantages, with the added consideration of weight gain potential, as seen with other antipsychotics like olanzapine, clozapine, quetiapine, and risperidone, which are consistently associated with weight gain 1. In contrast, lurasidone, ziprasidone, and aripiprazole appear to be more weight-neutral options within the class of antipsychotics 1.
From the Research
Switching from Vraylar to Abilify
- Vraylar (cariprazine) and Abilify (aripiprazole) are both atypical antipsychotics used to treat schizophrenia and bipolar disorder.
- According to a study published in 2019 2, cariprazine has a higher incidence rate of akathisia (17.2%) compared to aripiprazole (10.0%).
- Another study from 2012 3 found that aripiprazole led to significantly more akathisia incidence in patients with affective disorders compared to those with schizophrenia.
- A 2021 review 4 on the pathophysiology and management of akathisia notes that even drugs that induce no other extrapyramidal side effects, such as aripiprazole, may still induce akathisia.
- A study from 2020 5 compared the effectiveness of different antipsychotics, including aripiprazole, in the treatment of first-episode psychosis and found that aripiprazole had a lower treatment discontinuation rate compared to other antipsychotics.
- When switching from Vraylar to Abilify, patients should be monitored for potential side effects, including akathisia, and the dosage should be adjusted accordingly.
Potential Side Effects
- Akathisia is a common side effect of atypical antipsychotics, including aripiprazole and cariprazine.
- Other potential side effects of aripiprazole include extrapyramidal symptoms, weight gain, and sedation.
- The severity of akathisia can range from mild to severe and may be accompanied by dysphoria and purposeless movement.
Management of Akathisia
- Propranolol and low-dose mirtazapine are commonly used to manage akathisia 4.
- Benzodiazepines, voltage-gated calcium channel blockers, and opioids may also be effective in managing akathisia.
- Discontinuation of the causative drug and use of symptomatic relief medications may be necessary in some cases.