Psychiatrienet - User contributions [en]

SwitchAntipsychotics

2009-09-11T14:27:40Z

Verena:

SwitchAntipsychotics

2009-09-03T11:45:55Z

Verena:

<div align="center">
'''Switching Antipsychotics'''

To see the consequences of a switch between antipsychotics click in the crosstable below:
the switch is made "from" (vertical) "to" (horizontal). During switching: don't reduce anticholinergics and adding oxazepam might be useful.

{{Switchtable21
| head1 = ↓ from
| head2 = to →
| titel =
| afk01 = Am | med01 = Amisulpride
| afk02 = Ar | med02 = Aripiprazole
| afk03 = Ch | med03 = Chlorpromazine
| afk04 = Cp | med04 = Clozapine
| afk05 = Hp | med05 = Haloperidol
| afk06 = Ol | med06 = Olanzapine
| afk07 = Pi | med07 = Pimozide
| afk08 = Qu | med08 = Quetiapine
| afk09 = Rd | med09 = Risperidone
| afk10 = Sd | med10 = Sertindole
| afk11 = Sr | med11 = Sulpiride
| afk12 = Zi | med12 = Ziprasidone
| afk13 = RA | med13 = Rest AP
| afk14 = Df | med14 = Fluphenazine_LA
| afk15 = Di | med15 = Flupenthixol_LA
| afk16 = Dh | med16 = Haloperidol_LA
| afk17 = Do | med17 = Olanzapine_LA
| afk18 = Dp | med18 = Paliperidone_LA
| afk19 = Dr | med19 = Risperidone_LA
| afk20 = Dz | med20 = Zuclopenthixol_LA
| afk21 = Mz | med21 = Zuclopenthixol_MA | afk21 = Mz | txt21 = Zuclopenthixol MA

}}
'''LA''' = ''long acting'', '''MA''' = ''medium acting'' 
'''[[Rest AP]]''' = [[Chlorprothixene]], [[Flupentixol]], [[Loxapine]], [[Paliperidone]], [[Pericyazine]], [[Perphenazine]],[[Promazine]], [[Trifluoperazine]], [[Zuclopentixol]].
[[category:Switchtable]]

<div align="left">
'''General consideration'''

1. The goal of this switching table is to offer a guide for physician and pharmacist in switching antipsychotics. The table should be clear, easy to use and contain the most important information. Therefore, the table only contains the most common or special antipsychotics. There is also a group ‘rest AP’, containing antipsychotics with the same switching advice. 

2. It should be noted that the table only contains a general advice. 

3. Because of the risk of acute withdrawal symptoms (e.g. cholinergic rebound) and the risk of relapse, all antipsychotics are gradually tapered. 

4. The standard tapering period is approximately two weeks. The two drugs are cross-tapered, reducing and increasing the dose with approximately 25% every 2-3 days. 

5. To keep the content simple, dosages are given as percentages as much as possible. Dosages should be rounded to whole or half tablets. 

6. All antipsychotics are categorized in short, medium and long, based on their half-life. Depot preparations are categorized as long. It takes approximately 3-5 times the half-life for a drug to reach steady state plasma levels or to be completely eliminated. Switching two antipsychotics with approximately the same half-life are not expected to generate obvious problems. Also switching from a drug with a long half-life to a shorter half-life is in general not expected to give problems, because the new drug will reach steady state plasma levels more quickly. 

7. Switching from a drug with a short half life to a drug with a long half life is possibly more problematic. Plasma levels of the first drug decrease rapidly, while the second drug takes longer to reach a steady state plasma level. To overcome possible withdrawal/ relapse, the second drug should be started in a higher dose (approx. 50% of target dose) for about 4 days. Subsequently increase with 25% every 3-4 days. 

8. Warnings and advice are limited to the switch only. Specific drug properties can be found via the links on the right. 

9. Cytochrome P450 drug interactions between different antipsychotics are checked with the Flockart interaction table. No inductors or inhibitors were found. 

10. Nearly all antipsychotics increase the risk of QT time prolongation with or without Torsade de Pointes (TDP). Under the heading ‘more information’ there is a recommendation, advising ECG monitoring. The SPC of sertindole contains the warning ECG monitoring required. No distinction has been made between drugs with and without TDP.

SwitchAntipsychotics

2009-09-03T11:43:52Z

Verena:

<div align="center">
'''Switching Antipsychotics'''

To see the consequences of a switch between antipsychotics click in the crosstable below:
the switch is made "from" (vertical) "to" (horizontal). During switching: don't reduce anticholinergics and adding oxazepam might be useful.

{{Switchtable21
| head1 = ↓ from
| head2 = to →
| titel =
| afk01 = Am | med01 = Amisulpride
| afk02 = Ar | med02 = Aripiprazole
| afk03 = Ch | med03 = Chlorpromazine
| afk04 = Cp | med04 = Clozapine
| afk05 = Hp | med05 = Haloperidol
| afk06 = Ol | med06 = Olanzapine
| afk07 = Pi | med07 = Pimozide
| afk08 = Qu | med08 = Quetiapine
| afk09 = Rd | med09 = Risperidone
| afk10 = Sd | med10 = Sertindole
| afk11 = Sr | med11 = Sulpiride
| afk12 = Zi | med12 = Ziprasidone
| afk13 = RA | med13 = Rest AP
| afk14 = Df | med14 = Fluphenazine_LA
| afk15 = Di | med15 = Flupenthixol_LA
| afk16 = Dh | med16 = Haloperidol_LA
| afk17 = Do | med17 = Olanzapine_LA
| afk18 = Dp | med18 = Paliperidone_LA
| afk19 = Dr | med19 = Risperidone_LA
| afk20 = Dz | med20 = Zuclopenthixol_LA
| afk21 = Mz | med21 = Zuclopenthixol_MA | afk21 = Mz | txt21 = Zuclopenthixol MA

}}
'''LA''' = ''long acting'', '''MA''' = ''medium acting'' 
'''[[Rest AP]]''' = [[Chlorprothixene]], [[Flupentixol]], [[Loxapine]], [[Paliperidone]], [[Pericyazine]], [[Perphenazine]],[[Promazine]], [[Trifluoperazine]], [[Zuclopentixol]].
[[category:Switchtable]]

<div align="left">
'''General consideration'''

1. The goal of this switching table is to offer a guide for physician and pharmacist in switching antipsychotics. The table should be clear, easy to use and contain the most important information. Therefore, the table only contains the most common or special antipsychotics. There is also a group ‘rest AP’, containing antipsychotics with the same switching advice. 

2. It should be noted that the table contains a general advice. 

3. Because of the risk of acute withdrawal symptoms (cholinergic rebound) and the risk of relapse, all antipsychotics are gradually tapered. 

4. The standard tapering period is approximately two weeks. The two drugs are cross-tapered, reducing and increasing the dose with approximately 25% every 2-3 days. 

5. To keep the content simple, dosages are given as percentages as much as possible. Dosages should be rounded to whole or half tablets. 

6. All antipsychotics are categorized in short, medium and long, based on their half-life. Depot preparations are categorized as long. It takes approximately 3-5 times the half-life for a drug to reach steady state plasma levels or to be completely eliminated. Switching two antipsychotics with approximately the same half-life are not expected to generate obvious problems. Also switching from a drug with a long half-life to a shorter half-life is in general not expected to give problems, because the new drug will reach steady state plasma levels more quickly. 

7. Switching from a drug with a short half life to a drug with a long half life is possibly more problematic. Plasma levels of the first drug decrease rapidly, while the second drug takes longer to reach a steady state plasma level. To overcome possible withdrawal/ relapse, the second drug should be started in a higher dose (approx. 50% of target dose) for about 4 days. Subsequently increase with 25% every 3-4 days. 

8. Warnings and advice are limited to the switch only. Specific drug properties can be found via the links on the right. 

9. Cytochrome P450 drug interactions between different antipsychotics are checked with the Flockart interaction table. No inductors or inhibitors were found. 

10. Nearly all antipsychotics increase the risk of QT time prolongation with or without Torsade de Pointes (TDP). Under the heading ‘more information’ there is a recommendation, advising ECG monitoring. The SPC of sertindole contains the warning ECG monitoring required. No distinction has been made between drugs with and without TDP.

SwitchAntipsychotics

2009-09-03T10:00:32Z

Verena: Undo revision 3700 by Verena (Talk)

SwitchAntipsychotics

2009-09-03T09:59:47Z

Verena:

Bupropion-venlafaxine

2009-09-01T13:12:56Z

Verena:

{{Drugswitch
| from = bupropion
| to = venlafaxine
| stop =
* Gradually reduce dosage of bupropion to a maximum of 150 mg/day.
* When a dosage of 150 mg/day is reached, stop administration.<ref> Kennedy et al, [http://www.ncbi.nlm.nih.gov/pubmed/11926715?ordinalpos=11&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum Combining bupropion SR with venlafaxine, paroxetine, or fluoxetine: a preliminary report on pharmacokinetic, therapeutic, and sexual dysfunction effects.]. J Clin Psychiatry 2002 March;63(3):181-6.</ref>
| start =
* '''Day 1-7:''' a wash-out period of at least one week is necessary.
* '''Day 8:''' start venlafaxine in a normal dosage of 37,5 mg or 75 mg (slow release) /day.
| info =
* By considering a wash-out period of one week (5 times the elimination time of bupropion and its metabolites) it is assured that all bupropion has left the body and no drug interactions occur.
* Bupropion slows the metabolism of venlafaxine by CYP2D6.
}}

Bupropion-venlafaxine

2009-09-01T12:53:36Z

Verena:

{{Drugswitch
| from = bupropion
| to = venlafaxine
| stop =
* Gradually reduce dosage of bupropion to a maximum of 150 mg/day.
* When a dosage of 150 mg/day is reached, stop administration.
| start =
* '''Day 1-7:''' a wash-out period of at least one week is necessary.
* '''Day 8:''' start venlafaxine in a normal dosage of 37,5 mg or 75 mg (slow release) /day.
| info =
* By considering a wash-out period of one week (5 times the elimination time of bupropion and its metabolites) it is assured that all bupropion has left the body and no drug interactions occur.
* Bupropion slows the metabolism of venlafaxine by CYP2D6.<ref> Stöllberger C, Huber JO, Finsterer J, [http://www.ncbi.nlm.nih.gov/pubmed/16096514?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum Antipsychotic drugs and QT prolongation]. Int Clin Psychopharmacol. 2005 Sep;20(5):243-51.</ref>
}}

Citalopram-tranylcypromine

2009-08-31T14:26:13Z

Verena:

{{Drugswitch
| from = citalopram
| to = tranylcypromine
| stop =
* '''Day 0:''' gradually reduce dosage of citalopram/escitalopram to a maximum of 20 mg/ day resp. 10 mg/day, when this dosage is respectively > 20 mg/day and > 10 mg/day.
* '''Day 1:''' Reduce dosage of citalopram/escitalopram to a maximum of 10 mg/ day resp. 5 mg/day.
* '''Day 8:''' stop administration of citalopram/escitalopram.
| start =
* '''Day 8-21:''' a wash-out period of two weeks is necessary.
* '''Day 22:''' Start administration of tranylcypromine in low dosage of 20 mg/day for one week.
* '''Day 29:''' after this week the dosage of tranylcypromine can be increased if necessary.
| caveat =
* Occurrence of serotonin syndrome is reported when a wash-out period (of two weeks) is not considered.
}}

Amisulpride-Chlorpromazine

2009-08-28T14:05:49Z

Verena:

{{Drugswitch
| from = Amisulpride
| to = Chlorpromazine
| stop = {{StopStand}}
| start = {{StartStand}}
| info = {{caveQT}}
| view = Switchstandaardup en down.jpg
}}

Zuclopenthixol MA-Risperidone LA

2009-08-27T09:57:27Z

Verena:

{{Drugswitch
| from = Zuclopenthixol_MA
| to = Risperidone_LA
| stop = {{lastinjection}}
| start = {{StartDepot}}
* '''Day 1-21:''' Supplement orally
| view = empty.jpg
| info = {{caveQT}}{{Zuclopenthixol_MA}}
}}

Zuclopenthixol MA-Fluphenazine LA

2009-08-27T09:55:14Z

Verena:

{{Drugswitch
| from = Zuclopenthixol_MA
| to = Fluphenazine_LA
| stop = {{lastinjection}}
| start = {{StartDepot}}
| view = empty.jpg
| info = {{caveQT}}
}}

Zuclopenthixol MA-Flupenthixol LA

2009-08-27T09:55:00Z

Verena:

{{Drugswitch
| from = Zuclopenthixol_MA
| to = Flupenthixol_LA
| stop = {{lastinjection}}
| start = {{StartDepot}}
| view = empty.jpg
| info = {{caveQT}}{{Zuclopenthixol_MA}}
}}

Zuclopenthixol MA-Haloperidol LA

2009-08-27T09:54:28Z

Verena:

{{Drugswitch
| from = Zuclopenthixol_MA
| to = Haloperidol_LA
| stop = {{lastinjection}}
| start = {{StartDepot}}
| view = empty.jpg
| info = {{caveQT}}{{Zuclopenthixol_MA}}
}}

Zuclopenthixol MA-Olanzapine LA

2009-08-27T09:53:32Z

Verena:

{{Drugswitch
| from = Zuclopenthixol_MA
| to = Olanzapine_LA
| stop = {{lastinjection}}
| start = {{StartDepot}}
| view = empty.jpg
| info = {{caveQT}}{{Zuclopenthixol_MA}}
}}

Zuclopenthixol MA-Paliperidone LA

2009-08-27T09:53:18Z

Verena:

{{Drugswitch
| from = Zuclopenthixol_MA
| to = Paliperidone_LA
| stop = {{lastinjection}}
| start = {{StartDepot}}
{{NAY}}
| view = empty.jpg
| info = {{caveQT}}{{Zuclopenthixol_MA}}
}}

Zuclopenthixol MA-Zuclopenthixol LA

2009-08-27T09:52:50Z

Verena:

{{Drugswitch
| from = Zuclopenthixol_MA
| to = Zuclopenthixol_LA
| stop = {{lastinjection}}
| start = {{StartDepot}}
| view = empty.jpg
| info = {{caveQT}}{{Zuclopenthixol_MA}}
}}

Risperidone LA-Rest AP

2009-08-26T14:48:23Z

Verena:

{{Drugswitch
| from = Risperidone_LA
| to = Rest AP
| stop = {{Lastinjection}}
| start = {{Start5week}}
| info = {{caveQT}}
| view = StopRisperLAStartOral.jpg
}}

Risperidone LA-Ziprasidone

2009-08-26T14:48:01Z

Verena:

{{Drugswitch
| from = Risperidone_LA
| to = Ziprasidone
| stop = {{Lastinjection}}
| start = {{Start5week}}
| info = {{caveQT}}
| view = StopRisperLAStartOral.jpg
}}

Risperidone LA-Sulpiride

2009-08-26T14:47:44Z

Verena:

{{Drugswitch
| from = Risperidone_LA
| to = Sulpiride
| stop = {{Lastinjection}}
| start = {{Start5week}}
| info = {{caveQT}}
| view = StopRisperLAStartOral.jpg
}}

Risperidone LA-Sertindole

2009-08-26T14:47:24Z

Verena:

{{Drugswitch
| from = Risperidone_LA
| to = Sertindole
| stop = {{Lastinjection}}
| start = {{Start5week}}
| caveat = {{cavesertindole}}
| view = StopRisperLAStartOral.jpg
}}

Risperidone LA-Risperidone

2009-08-26T14:47:05Z

Verena:

{{Drugswitch
| from = Risperidone_LA
| to = Risperidone
| stop = {{Lastinjection}}
| start = {{Start5week}}
| info = {{caveQT}}
| view = StopRisperLAStartOral.jpg
}}

Risperidone LA-Quetiapine

2009-08-26T14:46:47Z

Verena:

{{Drugswitch
| from = Risperidone_LA
| to = Quetiapine
| stop = {{Lastinjection}}
| start = {{Start5week}}
| info = {{caveQT}}
| view = StopRisperLAStartOral.jpg
}}

Risperidone LA-Pimozide

2009-08-26T14:46:31Z

Verena:

{{Drugswitch
| from = Risperidone_LA
| to = Pimozide
| stop = {{Lastinjection}}
| start = {{Start5week}}
| info = {{caveQT}}
| view = StopRisperLAStartOral.jpg
}}

Risperidone LA-Olanzapine

2009-08-26T14:46:14Z

Verena:

{{Drugswitch
| from = Risperidone_LA
| to = Olanzapine
| stop = {{Lastinjection}}
| start = {{Start5week}}
| info = {{caveQT}}
| view = StopRisperLAStartOral.jpg
}}

Risperidone LA-Haloperidol

2009-08-26T14:46:00Z

Verena:

{{Drugswitch
| from = Risperidone_LA
| to = Haloperidol
| stop = {{Lastinjection}}
| start = {{Start5week}}
| info = {{caveQT}}
| view = StopRisperLAStartOral.jpg
}}

Risperidone LA-Chlorpromazine

2009-08-26T14:45:43Z

Verena:

{{Drugswitch
| from = Risperidone_LA
| to = Chlorpromazine
| stop = {{Lastinjection}}
| start = {{Start5week}}
| info = {{caveQT}}
| view = StopRisperLAStartOral.jpg
}}

File:StopRisperLAStartOral.jpg

2009-08-26T14:44:59Z

Verena:

Risperidone LA-Amisulpride

2009-08-26T14:44:38Z

Verena:

{{Drugswitch
| from = Risperidone_LA
| to = Amisulpride
| stop = {{Lastinjection}}
| start = {{Start5week}}
| info = {{caveQT}}
| view = StopRisperLAStartOral.jpg
}}

Zuclopenthixol LA-Aripiprazole

2009-08-26T14:26:17Z

Verena:

{{Drugswitch
| from = Zuclopenthixol_LA
| to = Aripiprazole
| stop = {{Lastinjection}}
| start = {{StartArip}}
| info = {{caveQT}}
| view = StopDepotStartArip.jpg
}}

Haloperidol LA-Aripiprazole

2009-08-26T14:25:39Z

Verena:

{{Drugswitch
| from = Haloperidol_LA
| to = Aripiprazole
| stop = {{Lastinjection}}
| start = {{StartArip}}
| info = {{caveQT}}
| view = StopDepotStartArip.jpg
}}

Flupenthixol LA-Aripiprazole

2009-08-26T14:25:22Z

Verena:

{{Drugswitch
| from = Flupenthixol_LA
| to = Aripiprazole
| stop = {{Lastinjection}}
| start = {{StartArip}}
| info = {{caveQT}}
| view = StopDepotStartArip.jpg
}}

Fluphenazine LA-Aripiprazole

2009-08-26T14:25:00Z

Verena:

{{Drugswitch
| from = Fluphenazine_LA
| to = Aripiprazole
| stop = {{Lastinjection}}
| start = {{Start}}
| info = {{caveQT}}
| view = StopDepotStartArip.jpg
}}

File:StopDepotStartArip.jpg

2009-08-26T14:24:38Z

Verena: uploaded a new version of "File:StopDepotStartArip.jpg"

File:StopDepotStartArip.jpg

2009-08-26T14:21:47Z

Verena:

Olanzapine LA-Aripiprazole

2009-08-26T14:21:34Z

Verena:

{{Drugswitch
| from = Olanzapine_LA
| to = Aripiprazole
| stop = {{Lastinjection}}
| start = {{StartArip}}
| info = {{caveQT}}
| view = StopDepotStartArip.jpg
}}

Zuclopenthixol LA-Rest AP

2009-08-26T13:27:50Z

Verena:

{{Drugswitch
| from = Zuclopenthixol_LA
| to = Rest AP
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}

Olanzapine LA-Rest AP

2009-08-26T13:27:28Z

Verena:

{{Drugswitch
| from = Olanzapine_LA
| to = Rest AP
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}

Haloperidol LA-Rest AP

2009-08-26T13:27:11Z

Verena:

{{Drugswitch
| from = Haloperidol_LA
| to = Rest AP
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}

Flupenthixol LA-Rest AP

2009-08-26T13:26:51Z

Verena:

{{Drugswitch
| from = Flupenthixol_LA
| to = Rest AP
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}

Fluphenazine LA-Rest AP

2009-08-26T13:26:33Z

Verena:

{{Drugswitch
| from = Fluphenazine_LA
| to = Rest AP
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}

Zuclopenthixol LA-Ziprasidone

2009-08-26T13:26:19Z

Verena:

{{Drugswitch
| from = Zuclopenthixol_LA
| to = Ziprasidone
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}

Olanzapine LA-Ziprasidone

2009-08-26T13:26:01Z

Verena:

{{Drugswitch
| from = Olanzapine_LA
| to = Ziprasidone
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}

Haloperidol LA-Ziprasidone

2009-08-26T13:25:44Z

Verena:

{{Drugswitch
| from = Haloperidol_LA
| to = Ziprasidone
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}

Flupenthixol LA-Ziprasidone

2009-08-26T13:25:29Z

Verena:

{{Drugswitch
| from = Flupenthixol_LA
| to = Ziprasidone
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}

Fluphenazine LA-Ziprasidone

2009-08-26T13:25:15Z

Verena:

{{Drugswitch
| from = Fluphenazine_LA
| to = Ziprasidone
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}

Zuclopenthixol LA-Sulpiride

2009-08-26T13:24:57Z

Verena:

{{Drugswitch
| from = Zuclopenthixol_LA
| to = Sulpiride
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| caveat = {{cavesertindole}}
| view = StopDepotStartOral.jpg
}}

Olanzapine LA-Sulpiride

2009-08-26T13:24:38Z

Verena:

{{Drugswitch
| from = Olanzapine_LA
| to = Sulpiride
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}

Haloperidol LA-Sulpiride

2009-08-26T13:24:18Z

Verena:

{{Drugswitch
| from = Haloperidol_LA
| to = Sulpiride
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}

Flupenthixol LA-Sulpiride

2009-08-26T13:24:02Z

Verena:

{{Drugswitch
| from = Flupenthixol_LA
| to = Sulpiride
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}

Fluphenazine LA-Sulpiride

2009-08-26T13:23:43Z

Verena:

{{Drugswitch
| from = Fluphenazine_LA
| to = Sulpiride
| stop = {{Lastinjection}}
| start = {{Startslweeks}}
| info = {{caveQT}}
| view = StopDepotStartOral.jpg
}}