2004 issue 3


Volume 20, issue 3


Switching of atypical neuroleptics in hospitalized patients

Bartosz Łoza1,2, Mariusz Bartyzel2
1. II Klinika Psychiatryczna Akademii Medycznej w Warszawie
2. Oddział Psychiatryczny w Janowie Lubelskim
Farmakoterapia w Psychiatrii i Neurologii, 2004, 3, 351-366
Keywords: switching of antipsychotics, classical antipsychotics, atypical antipsychotics


Background: Starting as early as from newly-admitted patients, searching and staying on the antipsychotic medication that works best and has the fewest side-effects still remains a process of trial and error. Moreover, the clinical consequences of the antipsychotic switching are even less determined and differentiated between various compounds. In such a situation, the well-known benefits of the atypical antipsychotic treatment should be considered and influence the switching algorithms.
Aim: We investigated the patterns of switching from or to different atypical antipsychotics in a group of hospitalized patients.
Methods: In a retrospective follow-up study of 112 mostly schizophrenic patients (65.2%), hospitalized during 0l/Jan/2003 – 29/Feb/2004, we applied a case-control analysis. We tracked 141 episodes of switching, multiplied in some cases. Switched patients were administered clozapine, olanzapine (generic – Zolafren and original – Zyprexa), risperidone, and a depot form of classical neuroleptics. Side-effects and side-effect-related auxiliary treatment were rated. Only patients, who completed their hospitalization with a clinical improvement, were included to the study.
Results: Typical antipsychotics and risperidone were the most frequently exchanged compounds and patients were switched mostly to olanzapine. The average doses of olanzapine (in equivalents) could be elevated safely comparing to classical antipsychotics (before switch) and risperidone (after switch). The olanzapine treatment was associated with less frequently observed side-effects and less commonly co-administered auxiliary medicines as compared to the pooled risperidone and typicals data. Clozapine was administered successfully in a small group of switched treatment resistant schizophrenic patients.
Conclusions: Atypical antipsychotics were less frequently associated with switching in comparison with classical antipsychotics suggesting their overall better tolerance and efficacy. Switching to olanzapine appeared to be the most preferential pattern because of the inadequate efficacy of other antipsychotic agent s in a substantial proportion of patients or patients' inability to tolerate them. Cross-titrated original (Zyprexa) and generic (Zolafren) forms of olanzapine were indistinguishable across all variables.