Commentary on strategies for switching antipsychotics
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BioMed Central
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Commentary
Commentary on strategies for switching antipsychotics John M Davis*1 and Stefan Leucht2 Address: 1Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL 60612, USA and 2Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, Ismaningerstrasse, 81675 Munich, Germany Email: John M Davis* - [email protected]; Stefan Leucht - [email protected] * Corresponding author
Published: 30 June 2008 BMC Medicine 2008, 6:18
doi:10.1186/1741-7015-6-18
Received: 2 April 2008 Accepted: 30 June 2008
This article is available from: http://www.biomedcentral.com/1741-7015/6/18 © 2008 Davis and Leucht; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Both the new generation of antipsychotics and the more traditional antipsychotic drugs produce an important and meaningful improvement in patients with schizophrenia, but most patients are neither cured nor free of symptoms. As a consequence, it is common to switch from one drug to another in the hope of obtaining a better response. All antipsychotic drugs produce some side effects, so switching can also be a tolerance issue. There are reports in the literature on the tactics of switching: abrupt discontinuation, cross tapering, starting a patient on a new drug while continuing with the old drug until the new drug has reached a steady state, or some variation on these tactics. In this issue, Ganguli et al. have carried out a randomized switching study, the data from which indicates the tactics that might be optimal. We put this paper into context, provide a critique and describe indications for switching.
Background Ganguli et al. [1] studied the strategy of switching patients from olanzapine to risperidone. They found that slow tapering of the initial antipsychotic after the new drug had been titrated to the full dose produces fewer problems during the switch than abrupt discontinuation or gradual discontinuation before starting a new drug. The abrupt discontinuation of clozapine does produce an acute worsening of psychosis in some patients and side effects as a result of withdrawal [2]. It is possible that some withdrawal side effects arise from the discontinuation of antipsychotic drugs and/or the antiparkinsonian drugs (often co-administered to reduce extrapyramidal side effects). It is less clear whether this occurs with other antipsychotic drugs [2]. Olanzapine has many pharmacological similarities to clozapine, so it is plausible that such phenomena could occur. Problems that might occur on switching include rebound worsening of psychotic symp-
toms, side effects, such as the addition of side effects of the old and new drugs, or side effects specific to the new drug, or differences i
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