Switching Anti-Psychotic Medications
Adapted from: “Switching Antipsychotic Medications”, Trust Brochures, Peter J. Weiden, MD, Aug 2001.
Getting Ready to Switch
1. You and your doctor should discuss the pros and cons of each medication and pick the one you are going to switch to.
2. It is impossible to know ahead of time exactly how your body and brain will react to going off your old medication and starting the new one.
3. While you are going through this switch, you need to make it the most important thing in your life – your top priority.
4. You may have to think of postponing other goals and priorities during the period of this switch.
5. Before you make the switch, you and your doctor will probably make a switching plan that is sometimes called a “medication crossover.”
Making the Switch
What is a Medication Crossover?
1. Your doctor will probably recommend staying on your old medication for a while rather than going off it “cold turkey.”
2. Most of the time, you’ll start by taking the new medication along with your old medication.
3. Your doctor will probably have you slowly raise the dose of the new medication, while slowly lower the dose of the old medication.
4. This process of overlapping medications is called a medication crossover.
5. It means that you will be taking two antipsychotic medications at once for a while. This will give the new medication time to begin “to work” while the old one is still working for you.
6. Other reasons for doing a medication crossover are that it makes it less likely you’ll have withdrawal reactions from going off your old medication too quickly and less likely you’ll get bothersome side effects from your new medication.
7. After a while, the doctor will decrease your old medication a little at a time.
8. The hope is that you will be able to stop taking your old medication and just take the new one without having any increase in symptoms.
How Long Will it Take for the New Medication to Work?
1. There is a delay between the time when you start a new antipsychotic medication and the time when benefits start to happen.
2. Generally, it takes about 4 to 6 weeks after you get to an adequate therapeutic dose for most antipsychotic medications to begin to help.
3. However, it can take as long as a couple of months for some conditions and some medications. It is as if your brain chemistry doesn’t really “figure out” that it is receiving a new medication until then.
4. Unfortunately, this is less true for side effects – you will often feel the side effects of a medication before its benefits.
After Switching Medication – Now What?
1. It is best to be cautiously optimistic when you are trying a new medication.
2. Unless you have been on a medication before, there is no way to know whether or not it will work for you.
3. Don’t give up too soon on a new medication as you may miss out on the benefits you might have gotten later on.
4. Talk with your doctor and treatment team about how things are going for you.
How Can I Tell If the New Medication Is Working?
1. It is helpful to know ahead of time what you want the new medication to do.
2. You may want it to control your symptoms better or you may want it to have fewer side effects.
3. You can monitor yourself to see if there has been any change in the level of your target symptoms or side effects.
4. Be aware that early signs of improvements are often subtle so don’t jump to conclusions too soon.
5. Watch for trends over a period of at least a week or more.
What if the New Medication Doesn’t Work for Me?
1. While you are bound to feel disappointed, don’t become discouraged because there are other options.
2. Here are some strategies that your doctor might recommend if a new medication has not worked as well as you hoped it would:
a. Adjusting the dose
b. Adding other medicines
c. Going back to the medication you were on before trying this one
d. Trying another one of the newer atypical antipsychotics
e. Trying one of the older antipsychotics
f. Trying a long-acting depot injection if taking oral medication has been a problem
g. Trying clozapine (Clozaril)
3. The pros of cons of these options are something to discuss with your doctor and your treatment team.
4. If the new medication has helped your symptoms but has caused some new side effects, you will need to consider the pros and cons of staying on the new medication or trying another new medication.