Switching from Aripiprazole to Lurasidone

Introduction to Switching Strategy

The American Psychiatric Association recommends a gradual taper of aripiprazole over 2 weeks while initiating lurasidone to minimize treatment failure and allow time for receptor adaptation, as aripiprazole is a partial D2 agonist while lurasidone is a full D2 antagonist 1

For patients with severe renal impairment, the maximum dose of lurasidone should not exceed 80 mg/day, according to the National Kidney Foundation 2
Aripiprazole 5mg is a relatively low dose, and starting lurasidone at the lower end of the therapeutic range (20mg) minimizes the risk of adverse effects during the transition period, as reported by The Lancet Psychiatry 1
The patient may be sensitive to antipsychotic effects, and common lurasidone adverse effects include somnolence, akathisia, nausea, and parkinsonism, which are dose-related, as noted in The Lancet Psychiatry 1

Parkinsonism/extrapyramidal symptoms should be monitored, as reported in The Lancet Psychiatry 4
The gradual cross-titration allows time for receptor adaptation, and abrupt discontinuation of aripiprazole could lead to withdrawal symptoms or symptom exacerbation, as noted in The Lancet Psychiatry 4