A Review of Pharmacologic Strategies for Switching to Atypical Antipsychotics

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Background: In daily clinical practice, frequent switching of antipsychotic medications is widespread. There are various reasons for switching, including a partial or complete lack of efficacy, adverse side effects, and partial or noncompliance with medication. Patients switched from conventional drugs to oral atypical antipsychotic drugs have been shown to benefit from significant improvements in clinical response and tolerability. This review examines the strategies for switching patients from conventional antipsychotic drugs to both oral and long-acting formulations of atypical antipsychotic drugs that are the recommended treatment in the majority of patients with schizophrenia.

Data Sources and Study Selection: An electronic literature search of relevant studies using MEDLINE (January 1994-June 2004) was performed using the search terms antipsychotic, atypical, conventional, schizophrenia, and switching. English-language articles, references from bibliographies of reviews, original research articles, and other articles of interest were reviewed.

Data Extraction and Synthesis: Data quality was determined by publication in the peer-reviewed literature and the most important information identified. Data from clinical trials suggest that switching to an atypical antipsychotic drug is beneficial for the patient with schizophrenia.

Conclusions: If initiated appropriately, switching to atypical antipsychotic medications should not compromise patient functioning; indeed, individualized strategies have been shown to provide continuous treatment efficacy. Switching to atypical antipsychotic therapy should, therefore, be employed as a pharmacologic strategy to maximize patient outcomes.

Prim Care Companion J Clin Psychiatry 2005;7(3):121-129