Strategies for Transitioning Therapy to Aripiprazole from Other Antipsychotics in Schizophrenia

OBJECTIVE: To determine the optimal approach for transitioning therapy to aripiprazole from other antipsychotics in schizophrenia and to describe these strategies. DATA SOURCES: MEDLINE (January 2000-March 2012) and PubMed (January 2000-March 2012) searches were conducted using the search terms aripiprazole, switch, and switching. Citations from references were reviewed to identify additional primary literature. STUDY SELECTION AND DATA EXTRACTION: Articles identified as primary literature were considered for inclusion. Case series, opinion papers, and review articles were also examined. Literature was required to be in English. For evaluation purposes, included articles were randomized trials specifically comparing different switching strategies from an alternative antipsychotic to aripiprazole. Randomized trials and single-arm studies that evaluated the effect of a change to aripiprazole and reported switching methods were also reviewed but not evaluated. DATA SYNTHESIS: Aripiprazole, an atypical antipsychotic agent with a unique mechanism of action, causes fewer adverse effects when compared with other atypical antipsychotics. Patients unable to tolerate or unresponsive to their current regimens might benefit from a change to aripiprazole, but the best method for switching is unknown. Four randomized trials were identified that compared the efficacy, safety, and tolerability of at least 2 different switching strategies. The 5 strategies used a combination of immediate or titrated initiation of aripiprazole with immediate or tapered discontinuation of the current antipsychotic. A significant worsening of symptoms in the abrupt discontinuation group when compared with the combined tapered discontinuation groups was seen in 1 trial at week 2; however, all other comparisons yielded no significant differences among switching strategies. CONCLUSIONS: Strategies for transitioning therapy to aripiprazole from alternative antipsychotics in schizophrenia have been investigated in randomized trials, but studies have failed to establish a preferred method. Despite the lack of evidence, experts recommend an overlap strategy that includes maintaining the current antipsychotic dosage while titrating to a therapeutic dose of aripiprazole.