Switching antipsychotics: an updated review with a focus on quetiapine
Peter J Weiden*
Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, New
York, USA.
* To whom correspondence should be addressed.
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Abstract |
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Atypical antipsychotics offer broader efficacy and improved tolerability compared
with conventional agents. Many patients currently treated with conventional
antipsychotics continue to experience persistent symptoms or troublesome side effects
and may benefit from a change to one of the newer atypical agents. There are also
significant differences in the side-effect profiles of the atypicals, such that a switch
from one atypical agent to another could offer advantages to many patients.
Unfortunately, many clinicians remain uncertain about the switching process and are
reluctant to initiate change. The aim of this review is to identify the indications for
a switch in antipsychotic therapy with a focus on recent switching data for the atypical
antipsychotic, quetiapine. The clinical aspects of quetiapine's receptor binding
characteristics are reviewed including the implications of the low D2
antagonist properties that make quetiapine the treatment of choice when EPS persists
with other atypical antipsychotics. Practical guidelines are given for managing the
process of changeover, for avoiding pitfalls and for maximizing the chances of a
successful switch. For example, when managing the antipsychotic crossover, it is
important to consider the psychological effects of switching arising from symptom and
side-effect changes. Finally, advice is provided on the assessments necessary when
evaluating the success of a change in therapy, together with guidance on the optimal
duration of treatment trials.
Key Words:
schizophrenia, antipsychotics, partial response, quetiapine, anticholinergic, EPS, switching, withdrawal
