[Problems when switching antipsychotics]

Most patients with schizophrenia switch antipsychotics (APs) either due to lack of efficacy or due to side effects. Changing AP, especially switching from clozapine, may lead to deterioration in the patient's condition because of pharmacodynamic differences between the existing and the new AP. A meta-analysis including four studies found no differences between switch strategies while three recent studies each found a positive short term effect of a crossover strategy compared to an abrupt switch. Based on the lack of evidence we recommend a slow withdrawal with a crossover strategy when switching AP.