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Switching antipsychotic therapies.

P S Masand¹, S L Berry

¹Department of Psychiatry, State University of New York Health Science Center at Syracuse, NY 13210, USA.

The Annals of Pharmacotherapy

|February 17, 2000

Summary

Switching to atypical antipsychotics can improve psychotic symptoms and may reduce overall treatment costs for schizophrenia patients. These newer medications offer better efficacy and safety profiles compared to older conventional antipsychotics.

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Area of Science:

Psychiatry
Pharmacology
Clinical Medicine

Background:

Atypical antipsychotics demonstrate superiority over conventional antipsychotics in managing positive and negative psychotic symptoms.
These newer agents may also improve mood and cognitive functioning without exacerbating mood symptoms.
Atypical antipsychotics generally exhibit more favorable adverse effect profiles compared to conventional options.

Purpose of the Study:

To review the advantages of transitioning patients with schizophrenia or schizoaffective disorder between different antipsychotic classes.
To evaluate the potential for reduced overall treatment costs, despite higher initial acquisition prices for atypical antipsychotics, due to decreased relapse and hospitalization rates.

Main Methods:

A comprehensive MEDLINE search was performed for English-language articles published between January 1977 and January 1999.
Data sources included articles on efficacy, adverse effects, compliance, and pharmacoeconomics of both atypical and conventional antipsychotics.
Efficacy, safety, tolerability, and pharmacoeconomic data were primarily derived from large, multicenter, double-blind, controlled studies and relevant review articles.

Main Results:

Atypical antipsychotics are more effective than conventional antipsychotics in treating schizophrenia.
Significant differences exist in the adverse effect profiles, costs, and patient compliance rates between atypical and conventional antipsychotics.

Conclusions:

Switching antipsychotic therapies, whether from conventional to atypical, atypical to conventional, or between atypical agents, may benefit certain patients.
Antipsychotic switching strategies include gradual tapering and cross-over methods.

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