Antipsychotics switching strategies in real life: A longitudinal study in clinical practice
2012
Background and Objectives: Switching antipsychotics (APs) in the treatment
of mental ilnesses such as schizophrenia is common practice for clinicians as well as
a transitional moment associated with the possibility of adverse events and recurrence of
psychoses. As in recent years, AP switching strategies have received more attention, a
number of authors have recommended transitions with overlapping drug dosage regimens
in time (such as tapering, cross-tapering, plateau switching) over abrupt switches. However,
there is a paucity of data documenting how clinicians are switching APs in real life.
Moreover, the question if recently recommended switching strategies are converted into
everyday practice is still very much unanswered. The present investigation aims to study if
indeed there is a preference for tapered approaches over abrupt switching.
Methods: In a retrospective longitudinal descriptive study, electronic prescription data
from a large clinical psychiatric setting in the Netherlands were collected for the year
2007. Timelines of medication regimens were constructed for individual patients, enabling
to identify transitions between APs. As patients could have been subjected to multiple
switches in a given time period, transitions were expressed as episodes. Abrupt
switches were defined as switches having no overlap in time.
Results: From a total of 5322 AP prescriptions involving 1465 patients, a total of 180
episodes (associated with 158 patients) were identified where APs were switched. Of
these 180 episodes, 110 (61%) involved abrupt transitions. 70 episodes (39%) had overlap
in time with an average taper length of 16.1 (SEM 1.6) days.
Conclusions: In the majority of cases in the studied clinical setting, APs are switched
abruptly
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