Rationale and strategies for switching antipsychotics

Reasons for switching patients to different antipsychotic drugs and strategies for doing so are reviewed. Atypical antipsychotics have better adverse-effect profiles than conventional agents and may have subtle advantages in terms of efficacy. Patients who do not respond satisfactorily to one atypical antipsychotic agent my do so to another. Thus, many patients taking antipsychotic agents may benefit from a switch to another drug. However, the transition from one agent to another is itself associated with risks and uncertainties. Several switching strategies have been proposed that involve the abrupt or gradual initiation of the new drug. There are few data to suggest that one strategy is superior to another. A clinical appraisal of the conditions under which switching of drugs should occur and a careful evaluation of the appropriate strategy can help minimise the risks of switching. Planning and follow-up should include the patient, the patient's family, and social-support personnel. Guidelines for switching drugs and managing patients during the transition are being developed. When switching patients from one antipsychotic to another, good clinical judgement and a conservative approach can be used to balance the risk of clinical exacerbation with that of increased adverse effects.