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<span style="font-size:220%;">'''Switching Antipsychotics'''</span>
To see the consequences of a switch between antipsychotics click in the crosstable below:
the switch is made "from" (vertical) "to" (horizontal). <br />During switching: don't reduce anticholinergics and adding oxazepam might be useful.
{{Switchtable21| head1 = <span style="font-size:150%;">↓</span> <small>from</small>| head2 = <small>If you any have suggestions, please send them to</small><span style="font-size:200%;"> →</span>| 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 <small>MA</small>medisch@boom.nl. We are looking forward to your feedback.
}}'''LA''' = ''long acting'', '''MA''' = ''medium acting''<br />''During switching: don't reduce anticholinergics; consider adding oxazepam. Read: [[Rest AP]]''' = [[Chlorprothixene]], [[Flupentixol]], [[Loxapine]], [[Paliperidone]], [[Pericyazine]], [[Perphenazine]],[[Promazine]], [[Trifluoperazine]], [[ZuclopentixolGeneral considerations concerning switching antipsychotics]].[[category:Switchtable]]
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'''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'''[[Rest AP]]''' = [[Chlorprothixene]], [[Flupentixol]], [[Fluphenazine]] [[Loxapine]], [[Pericyazine]], [[Perphenazine]],[[Promazine]], easy to use and contain the most important information. Therefore[[Trifluoperazine]], the table only contains the most common or special antipsychotics. There is also a group ‘rest AP’[[Ziprasidone]], containing antipsychotics with the same switching advice[[Zuclopentixol]].<br />
2. It should be noted that the table only contains a general advice. '''[[Partial agonist]]''' <span style="color:#ff0000"><br /span>= [[Aripiprazole]], [[Brexpiprazole]], [[Cariprazine]].
3. Because of the risk of acute withdrawal symptoms {{Switchtable23x| head1 = <span style="font-size:150%;">↓</span> <small>from</small>| head2 = <small>to</small><span style="font-size:200%;"> →</span>| titel =| stop = Stop | afk01 = Am | med01 = Amisulpride|| afk02 = Cp | med02 = Clozapine|| afk03 = Hp | med03 = Haloperidol|| afk04 = Lu | med04 = Lurasidone|| afk05 = Ol | med05 = Olanzapine|| afk06 = Pp | med06 = Paliperidone|| afk07 = Pa | med07 = Partial agonist|| afk08 = Pf | med08 = Penfluridol|| afk09 = Pi | med09 = Pimozide|| afk10 = Qu | med10 = Quetiapine|| afk11 = Rd | med11 = Risperidone|| afk12 = Sd | med12 = Sertindole|| afk13 = Sr | med13 = Sulpiride|| afk14 = RA | med14 = Rest AP|| afk15 = Da | med15 = Aripiprazole_LA || afk16 = Di | med16 = Flupenthixol_LA|| afk17 = Df | med17 = Fluphenazine_LA|| afk18 = Dh | med18 = Haloperidol_LA|| afk19 = Do | med19 = Olanzapine_LA|| afk20 = Dp | med20 = Paliperidone_ER|| afk21 = Dr | med21 = Risperidone_LA|| afk22 = Dz | med22 = Zuclopenthixol_LA|| afk23 = Mz | med23 = Zuclopenthixol_MA |}}'''ER''' = ''extended release (e.g. cholinergic reboundXeplion® + Trivecta® + Byannli®) and the risk of relapse''', all antipsychotics are gradually tapered. ''LA''' = ''long acting'', '''MA''' = ''medium acting''<br />
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. <br /> 5. To keep the content simple, dosages are given as percentages as much as possible. Dosages should be rounded to whole or half tablets. <br /> 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. <br /> 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. <br /> 8. Warnings and advice are limited to the switch only. Specific drug properties can be found via the links on the right. <br /> 9. Cytochrome P450 drug interactions between different antipsychotics are checked with the Flockart interaction table. No inductors or inhibitors were found. <br /> 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.[[category:Switchtable]]
