Difference between revisions of "SwitchAntipsychotics"

From Psychiatrienet
Jump to: navigation, search
(wiki-syntax used)
(29 intermediate revisions by 4 users not shown)
Line 1: Line 1:
 
<div align="center">
 
<div align="center">
<span style="font-size:220%;">'''Switching Antipsychotics'''</span>
+
<span style="font-size:220%;">'''Switching Antipsychotics'''</span>
  
 
To see the consequences of a switch between antipsychotics click in the crosstable below:  
 
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.
+
the switch is made "from" (vertical) "to" (horizontal). <br />During switching: don't reduce dose of other anticholinergic drugs; consider adding oxazepam. Read: [[General considerations concerning switching antipsychotics]].
  
{{Switchtable21
+
 
 +
'''[[Rest AP]]''' = [[Chlorprothixene]], [[Flupentixol]], [[Loxapine]], [[Paliperidone]], [[Pericyazine]], [[Perphenazine]],[[Promazine]], [[Trifluoperazine]], [[Zuclopentixol]].
 +
 
 +
'''[[Partial antagonist]]''' = [[Aripiprazole]], [[Brexpiprazole]], [[Cariprazine]].
 +
 
 +
{{Switchtable23x
 
| head1 = <span style="font-size:150%;">↓</span>&nbsp;<small>from</small>
 
| head1 = <span style="font-size:150%;">↓</span>&nbsp;<small>from</small>
 
| head2 = <small>to</small><span style="font-size:200%;">&nbsp;→</span>
 
| head2 = <small>to</small><span style="font-size:200%;">&nbsp;→</span>
| titel =  
+
| titel =
 +
| stop = Stop
 
| afk01 = Am | med01 = Amisulpride
 
| afk01 = Am | med01 = Amisulpride
| afk02 = Ar | med02 = Aripiprazole
+
| afk02 = Ch | med02 = Chlorpromazine
| afk03 = Ch | med03 = Chlorpromazine
+
| afk03 = Cp | med03 = Clozapine
| afk04 = Cp | med04 = Clozapine
+
| afk04 = Hp | med04 = Haloperidol
| afk05 = Hp | med05 = Haloperidol
+
| afk05 = Lu | med05 = Lurasidone
 
| afk06 = Ol | med06 = Olanzapine
 
| afk06 = Ol | med06 = Olanzapine
| afk07 = Pi | med07 = Pimozide
+
| afk07 = Pa | med07 = Partial antagonist
| afk08 = Qu | med08 = Quetiapine
+
| afk08 = Pi | med08 = Pimozide
| afk09 = Rd | med09 = Risperidone
+
| afk09 = Qu | med09 = Quetiapine
| afk10 = Sd | med10 = Sertindole
+
| afk10 = Rd | med10 = Risperidone
| afk11 = Sr | med11 = Sulpiride
+
| afk11 = Sd | med11 = Sertindole
| afk12 = Zi | med12 = Ziprasidone
+
| afk12 = Sr | med12 = Sulpiride
| afk13 = RA | med13 = Rest AP
+
| afk13 = Zi | med13 = Ziprasidone
| afk14 = Df | med14 = Fluphenazine_LA
+
| afk14 = RA | med14 = Rest AP
| afk15 = Di | med15 = Flupenthixol_LA
+
| afk15 = Da | med15 = Aripiprazole_LA
| afk16 = Dh | med16 = Haloperidol_LA
+
| afk16 = Df | med16 = Fluphenazine_LA
| afk17 = Do | med17 = Olanzapine_LA
+
| afk17 = Di | med17 = Flupenthixol_LA
| afk18 = Dp | med18 = Paliperidone_LA
+
| afk18 = Dh | med18 = Haloperidol_LA
| afk19 = Dr | med19 = Risperidone_LA
+
| afk19 = Do | med19 = Olanzapine_LA
| afk20 = Dz | med20 = Zuclopenthixol_LA
+
| afk20 = Dp | med20 = Paliperidone_LA
| afk21 = Mz | med21 = Zuclopenthixol_MA | afk21 = Mz | txt21 = Zuclopenthixol <small>MA</small>
+
| afk21 = Dr | med21 = Risperidone_LA
 +
| afk22 = Dz | med22 = Zuclopenthixol_LA
 +
| afk23 = Mz | med23 = Zuclopenthixol_MA
 
}}
 
}}
 
'''LA''' = ''long acting'', '''MA''' = ''medium acting''<br />
 
'''LA''' = ''long acting'', '''MA''' = ''medium acting''<br />
'''[[Rest AP]]''' = [[Chlorprothixene]], [[Flupentixol]], [[Loxapine]], [[Paliperidone]], [[Pericyazine]], [[Perphenazine]],[[Promazine]], [[Trifluoperazine]], [[Zuclopentixol]].
+
 
 +
(part of www.psychiatrienet.nl)
 
</div>
 
</div>
 
 
'''General considerations'''
 
# 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.
 
# It should be noted that the table only contains a general advice.
 
# Because of the risk of acute withdrawal symptoms (e.g. cholinergic rebound) and the risk of relapse, all antipsychotics are gradually tapered.
 
# 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.
 
# To keep the content simple, dosages are given as percentages as much as possible. Dosages should be rounded to whole or half tablets.
 
# 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.
 
# 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.
 
# Warnings and advice are limited to the switch only. Specific drug properties can be found via the links on the right.
 
# Cytochrome P450 drug interactions between different antipsychotics are checked with the Flockart interaction table. No inductors or inhibitors were found.
 
# 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]]
 
[[category:Switchtable]]

Revision as of 17:24, 29 October 2021

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 dose of other anticholinergic drugs; consider adding oxazepam. Read: General considerations concerning switching antipsychotics.


Rest AP = Chlorprothixene, Flupentixol, Loxapine, Paliperidone, Pericyazine, Perphenazine,Promazine, Trifluoperazine, Zuclopentixol.

Partial antagonist = Aripiprazole, Brexpiprazole, Cariprazine.


 from to → Am Ch Cp Hp Lu Ol Pa Pi Qu Rd Sd Sr Zi RA Da Df Di Dh Do Dp Dr Dz
Am Amisulpride  — AmCh AmCp AmHp AmLu AmOl AmPa AmPi AmQu AmRd AmSd AmSr AmZi AmRA AmDa AmDf AmDi AmDh AmDo AmDp AmDr AmDz
Ch Chlorpromazine ChAm  — ChCp ChHp ChLu ChOl ChPa ChPi ChQu ChRd ChSd ChSr ChZi ChRA ChDa ChDf ChDi ChDh ChDo ChDp ChDr ChDz
Cp Clozapine CpAm CpCh  — CpHp CpLu CpOl CpPa CpPi CpQu CpRd CpSd CpSr CpZi CpRA CpDa CpDf CpDi CpDh CpDo CpDp CpDr CpDz
Hp Haloperidol HpAm HpCh HpCp  — HpLu HpOl HpPa HpPi HpQu HpRd HpSd HpSr HpZi HpRA HpDa HpDf HpDi HpDh HpDo HpDp HpDr HpDz
Lu Lurasidone LuAm LuCh LuCp LuHp  — LuOl LuPa LuPi LuQu LuRd LuSd LuSr LuZi LuRA LuDa LuDf LuDi LuDh LuDo LuDp LuDr LuDz
Ol Olanzapine new OlAm OlCh OlCp OlHp OlLu OlOl OlPa OlPi OlQu OlRd OlSd OlSr OlZi OlRA OlDa OlDf OlDi OlDh OlDo OlDp OlDr OlDz
Pa Partial antagonist PaAm PaCh PaCp PaHp PaLu PaOl  — PaPi PaQu PaRd PaSd PaSr PaZi PaRA PaDa PaDf PaDi PaDh PaDo PaDp PaDr PaDz
Pi Pimozide PiAm PiCh PiCp PiHp PiLu PiOl PiPa  — PiQu PiRd PiSd PiSr PiZi PiRA PiDa PiDf PiDi PiDh PiDo PiDp PiDr PiDz
Qu Quetiapine QuAm QuCh QuCp QuHp QuLu QuOl QuPa QuPi  — QuRd QuSd QuSr QuZi QuRA QuDa QuDf QuDi QuDh QuDo QuDp QuDr QuDz
Rd Risperidone RdAm RdCh RdCp RdHp RdLu RdOl RdPa RdPi RdQu  — RdSd RdSr RdZi RdRA RdDa RdDf RdDi RdDh RdDo RdDp RdDr RdDz
Sd Sertindole SdAm SdCh SdCp SdHp SdLu SdOl SdPa SdPi SdQu SdRd  — SdSr SdZi SdRA SdDa SdDf SdDi SdDh SdDo SdDp SdDr SdDz
Sr Sulpiride SrAm SrCh SrCp SrHp SrLu SrOl SrPa SrPi SrQu SrRd SrSd  — SrZi SrRA SrDa SrDf SrDi SrDh SrDo SrDp SrDr SrDz
Zi Ziprasidone ZiAm ZiCh ZiCp ZiHp ZiLu ZiOl ZiPa ZiPi ZiQu ZiRd ZiSd ZiSr ZiZi ZiRA ZiDa ZiDf ZiDi ZiDh ZiDo ZiDp ZiDr ZiDz
RA Rest AP RAAm RACh RACp RAHp RALu RAOl RAPa RAPi RAQu RARd RASd RASr RAZi  — RADa RADf RADi RADh RADo RADp RADr RADz
Da Aripiprazole_LA DaAm DaCh DaCp DaHp DaLu DaOl DaPa DaPi DaQu DaRd DaSd DaSr DaZi DaRA  — DaDf DaDi DaDh DaDo DaDp DaDr DaDz
Df Fluphenazine_LA DfAm DfCh DfCp DfHp DfLu DfOl DfPa DfPi DfQu DfRd DfSd DfSr DfZi DfRA DfDa  — DfDi DfDh DfDo DfDp DfDr DfDz
Di Flupenthixol_LA DiAm DiCh DiCp DiHp DiLu DiOl DiPa DiPi DiQu DiRd DiSd DiSr DiZi DiRA DiDa DiDf  — DiDh DiDo DiDp DiDr DiDz
Dh Haloperidol_LA DhAm DhCh DhCp DhHp DhLu DhOl DhPa DhPi DhQu DhRd DhSd DhSr DhZi DhRA DhDa DhDf DhDi  — DhDo DhDp DhDr DhDz
Do Olanzapine_LA DoAm DoCh DoCp DoHp DoLu DoOl DoPa DoPi DoQu DoRd DoSd DoSr DoZi DoRA DoDa DoDf DoDi DoDh  — DoDp DoDr DoDz
Dp Paliperidone_LA DpAm DpCh DpCp DpHp DpLu DpOl DpPa DpPi DpQu DpRd DpSd DpSr DpZi DpRA DpDa DpDf DpDi DpDh DpDo  — DpDr DpDz
Dr Risperidone_LA DrAm DrCh DrCp DrHp DrLu DrOl DrPa DrPi DrQu DrRd DrSd DrSr DrZi DrRA DrDa DrDf DrDi DrDh DrDo DrDp  — DrDz
Dz Zuclopenthixol_LA DzAm DzCh DzCp DzHp DzLu DzOl DzPa DzPi DzQu DzRd DzSd DzSr DzZi DzRA DzDa DzDf DzDi DzDh DzDo DzDp DzDr  —

LA = long acting, MA = medium acting

(part of www.psychiatrienet.nl)