title: Switching atypical antipsychotics: a review.
abstract: BACKGROUND
  Atypical antipsychotics are increasingly used in the treatment of diverse psychiatric disorders; however, there is little information on the 'why, when, and how' of switching between the different atypical antipsychotics currently available.
  
  
  OBJECTIVE
  To review the data on switching and atypical antipsychotics.
  
  
  METHODS
  A literature search was initially conducted using the key words followed by a search of relevant articles including conference abstracts; relevant pharmaceutical companies were also contacted.
  
  
  RESULTS
  Clinical trial data are limited in terms of parameters measured, and case reports describe specific problems. Few studies are based on real world populations of psychiatric patients over the long-term. Careful patient and drug selections matched to a carefully supervised and appropriate cross titration based upon the pharmacodynamic and pharmacokinetic properties of all of the drugs involved is important to avoid potential complications such as re-emergence or worsening of psychosis and withdrawal, rebound, and emergent phenomena including new or uncovered side-effects. Psychoeducation and involvement of patients and caregivers in the process are also necessary for a successful switch.
  
  
  CONCLUSIONS
  Despite the prevalence of switching in real world clinical practice, there is a paucity of data to guide clinicians with respect to effective and safe strategies. There are no criteria defining a successful switch. With the increasing range and formulations of atypical antipsychotics available, there is a rationale for their early use to avoid the practical problems associated with switching from conventional antipsychotics as well as the opportunity to maintain patients on an optimal atypical antipsychotic monotherapy.
authors.affiliation: 1Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Chue
authors.affiliation: 2Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Stip
authors.affiliation: 3Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Remington
authors.affiliation: 4Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Lili
authors.initials: L
authors.lastname: Kopala