OK to switch antipsychotics suddenly or gradually in schizophrenia

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - When switching antipsychotic medications in patients with schizophrenia, clinical outcomes are similar whether the agent is stopped suddenly or gradually, according to a new systematic review and meta-analysis.

"The current antipsychotic medication can be discontinued either immediately or gradually. Clinicians should choose an antipsychotic switching strategy based on individual patient needs," said lead author Dr. Hiroyoshi Takeuchi of the Centre for Addiction and Mental Health in Toronto, Canada.

"In clinical practice, discontinuation is often gradual because of the widespread belief that this lowers the risks of symptom exacerbation, side effects, or both. However, immediate discontinuation may be better because it is simpler and because a stalled cross-titration process in antipsychotic switching may result in antipsychotic polypharmacy," he told Reuters Health by email.

Antipsychotic switching is routine but whether it's better to immediately stop the current antipsychotic or gradually taper it off is unclear. Abruptly stopping medication has been thought to play a role in rebound and withdrawal symptoms as well as the emergence and exacerbation of symptoms. Gradually changing from one to the other, on the other hand, is thought to lead to possible additive or synergistic side effects when used in a crossover approach.

Dr. Takeuchi and his colleagues systematically searched electronic databases for randomized controlled trials that compared immediate and gradual discontinuation in antipsychotic switching in schizophrenia, schizoaffective disorder, or both.

They found nine studies involving 1,416 patients, they report in a paper online January 2 in Schizophrenia Bulletin. There were no significant differences in clinical outcomes between the approaches in clinical outcomes including study discontinuation, extrapyramidal symptoms, psychopathology and treatment-emergent adverse events (p>0.05 for all).

In sensitivity analyses, though, there was a significant difference in insomnia favoring gradual discontinuation (risk ratio, 2.62; p=0.007) among patients switching to olanzapine.

Those switching to ziprasidone showed potential differences in Simpson-Angus Scale (SAS) scores and somnolence, also favoring gradual discontinuation (p=0.05 for both).

SOURCE: http://bit.ly/2lavkPt

Schizophr Bull 2017.

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