Stopping and switching antipsychotic drugs

In general, specialist advice should be sought when stopping or switching antipsychotics While antipsychotics are often needed long term, there are circumstances when clinicians, patients and families should reconsider the benefits versus the harms of continuing treatment Withdrawal syndromes, relapse and rebound can occur if antipsychotics are discontinued, especially if they are stopped abruptly. Generally, they should be reduced and stopped slowly, ideally over weeks to months Relapse of psychosis and exacerbation occur in most patients with psychotic disorders, occasionally with drastic consequences. Sometimes this occurs many months after stopping antipsychotics Switching from one antipsychotic to another is frequently indicated due to an inadequate treatment response or unacceptable adverse effects. It should be carried out cautiously and under close observation Keywords: antipsychotics, psychosis, drug withdrawal syndrome Introduction Stopping antipsychotic drug therapy is feasible and appropriate in a number of clinical circumstances. For patients who require long-term treatment, switching to another antipsychotic may be needed if their response to treatment has been inadequate, or unacceptable adverse effects have occurred. For patients with serious psychiatric illness, stopping or switching antipsychotics requires referral to a specialist if possible. However, for patients on small off-label doses of antipsychotics for behavioural disturbance in dementia or for sleep problems, it may be reasonable for the GP to taper the dose and stop treatment with careful monitoring.