Aripiprazole Tapering in a 67-Year-Old Male on Lamotrigine
Aripiprazole 10 mg can be discontinued gradually over 1–2 weeks by reducing to 5 mg daily for 7–14 days before stopping completely, with lamotrigine continued unchanged throughout the process.
Recommended Tapering Protocol
The optimal approach is a stepwise reduction rather than abrupt cessation:
- Reduce from 10 mg to 5 mg daily for 7–14 days, then discontinue 1, 2
- Aripiprazole reaches steady-state in approximately 14 days due to its long elimination half-life (75 hours for aripiprazole, 94 hours for its active metabolite), meaning full therapeutic effects—and conversely, complete washout—require 1–2 weeks and sometimes up to 4 weeks 2
- Gradual tapering prevents early symptom worsening and reduces premature treatment discontinuation compared to immediate cessation 1
Maintain lamotrigine at its current dose without adjustment during the aripiprazole taper 3. Lamotrigine is a sodium channel blocker used for mood stabilization and does not require dose modification when discontinuing aripiprazole 3.
Clinical Rationale for Gradual Discontinuation
Abrupt discontinuation of aripiprazole increases the risk of symptom rebound:
- In a randomized study of 77 patients, those switched off antipsychotics with immediate discontinuation showed increased symptom severity at week 1 compared to gradual tapers over 4–6 weeks 1
- The 4-week taper group (half-dose after 2 weeks, then complete discontinuation) demonstrated better symptom stability than immediate cessation 1
- Given aripiprazole's long half-life, a 1–2 week taper at half-dose (5 mg) provides adequate coverage while minimizing rebound risk 2
Monitoring Requirements During Taper
Assess for withdrawal or rebound symptoms weekly during the taper period:
- Monitor for worsening of the original indication (psychosis, mania, or mood instability) using standardized scales such as CGI-S or BPRS 1
- Evaluate for akathisia, restlessness, insomnia, anxiety, or gastrointestinal symptoms, which can emerge during dose changes 4
- In this 67-year-old patient, pay particular attention to cognitive function, gait stability, and orthostatic vital signs, as older adults may experience more pronounced side effects during medication transitions 3
Special Considerations for This Patient
Age-related factors warrant cautious monitoring but do not require a slower taper:
- Older adults (≥65 years) are at higher risk for cognitive impairment, falls, and medication-related adverse effects, necessitating close observation during any medication change 3, 5
- The patient's weight (200 lbs/~91 kg) is within normal range and does not require dose adjustment 6
- Lamotrigine continuation provides mood stabilization throughout the aripiprazole taper, reducing the risk of mood destabilization 3
Expected Timeline and Outcomes
Complete discontinuation should be achieved within 2–3 weeks:
- Week 1: Reduce aripiprazole from 10 mg to 5 mg daily 1, 2
- Week 2–3: Continue 5 mg daily for 7–14 days, then discontinue 1, 2
- Week 3–6: Monitor for delayed symptom emergence, as aripiprazole's long half-life means complete washout may take up to 4 weeks after the final dose 2
Most patients tolerate this taper well with minimal symptom worsening 1. If significant symptom rebound occurs during the 5 mg phase, extend that dose for an additional 1–2 weeks before complete discontinuation 1.
Critical Pitfalls to Avoid
Do not stop aripiprazole abruptly without a taper, as this increases the risk of symptom exacerbation and treatment discontinuation 1.
Do not reduce lamotrigine during the aripiprazole taper, as this could destabilize mood independently of the aripiprazole discontinuation 3.
Do not assume symptom stability at week 1 means the taper is complete—aripiprazole's long half-life requires monitoring for 3–4 weeks after the final dose to detect delayed rebound 2.