There is little documented experience with switching patients from conventional antipsychotics to the second generation agents; however, these treatment conversions are becoming increasingly common, and some general principles should be applied. It should be decided whether the current drug requires immediate discontinuation (ie, serious adverse drug reaction) or whether overlapping the two therapies is possible (ie, to minimize risk of relapse). With overlaps, the specific increments and timing of dosage changes should be on a flexible schedule and patients require close monitoring (eg, every day or two for inpatients and once or twice weekly for the more gradual overlaps completed for outpatients). buy antibiotics online
The initial dose, and rate of dose escalation and reduction should be chosen considering the patient’s age, history of drug tolerance and clinical status (eg, presence and severity of acute psychotic exacerbation). Patients switched from a low potency agent (such as chlorpromazine) to a second generation agent should be monitored for cholinergic rebound, although overlapping doses may limit this risk. When switching from clozapine to any other agent, early relapse is a concern . Achieving an effective dose of the new agent may be preferable before substantially reducing the dose of clozapine. Thereafter, clozapine can be gradually eliminated. When interchanging new agents for a high potency agent (such as ha-loperidol or risperidone), a cautious overlap should be tolerated reasonably well, although a transient increase in the risk of EPS and withdrawal dyskinesias will occur. This will, however, reduce the risk of decompensation during the transition.
During therapeutic interchanges, it is important to identify outcome objectives, including the rate of treatment transition, the time by which antipsychotic monotherapy should resume and target reductions of symptoms. An unfortunate outcome of many planned treatment switches is long term combination therapy with antipsychotics. This is usually of unproven benefit over monotherapy of the new agent and is certain to increase the risk of side effects and drug interactions as well as add significantly to the financial burden of drug treatment.