Cross-Tapering from Aripiprazole to Quetiapine

Monitoring and Tapering

• The Centers for Disease Control and Prevention, as reported by MMWR Recommendations and Reports, recommends following up frequently (at least monthly) during the cross-tapering process to monitor for signs of withdrawal or psychotic symptom exacerbation 1
• The American medical community, as informed by Annals of Oncology, notes that quetiapine has less risk of extrapyramidal symptoms than other atypical antipsychotics, and patients with hepatic impairment require reduced quetiapine dosing 2
• The medical guidelines, as outlined by MMWR Recommendations and Reports, suggest that if withdrawal symptoms emerge, slow the taper rate of aripiprazole, and for patients who have been on aripiprazole long-term (≥1 year), consider a slower taper over several months 1

Special Considerations

• The medical community, as reported by Annals of Oncology, advises that quetiapine is more sedating than aripiprazole, so consider administering a larger portion of the quetiapine dose at bedtime 2
• The medical guidelines, as informed by MMWR Recommendations and Reports, recommend avoiding abrupt discontinuation of aripiprazole, as this may lead to withdrawal symptoms or symptom exacerbation 1

Common Pitfalls to Avoid

• The medical community, as reported by Annals of Oncology, warns against increasing quetiapine too rapidly, as this may cause excessive sedation or orthostatic hypotension 2
• The medical guidelines, as outlined by Praxis Medical Insights, suggest that if the patient is also taking benzodiazepines and these need to be discontinued as well, prioritize tapering the benzodiazepines first due to higher risks associated with benzodiazepine withdrawal 3