Burns T, Chabannes J P, Demyttenaere K
Department of Psychiatry, St George's Hospital Medical School, London, UK.
Curr Med Res Opin. 2002;18(4):201-8. doi: 10.1185/030079902125000589.
As more and more novel antipsychotic agents are introduced, the need for practical guidelines on switching these medications is becoming increasingly important. Indications for a switch include situations where the patient or his family/caregiver requests a change in medication, where the patient cannot tolerate current treatment, where they have comorbid physical or psychiatric conditions or where they have achieved only a partial remission, are refractory to treatment or have relapsed. Cross-tapering is generally the most acceptable method of switching, although abrupt withdrawal may be necessary in some cases, such as when a patient develops a severe or acute reaction to their current treatment. Possible problems of switching include the risk of discontinuation reactions and the re-emergence of psychotic symptoms. The pharmacological profile of amisulpride means it has a relatively low potential for interactions with other drugs and may be started while discontinuing the previous antipsychotic. It should be started at the target dose for the patient's current symptoms. A retrospective questionnaire among 60 patients switching to amisulpride treatment was undertaken to identify the characteristics of patients switching antipsychotics and their reasons. Patients were switched from a variety of antipsychotic medications, both traditional (42% of patients) and atypical (58%). Most patients (87%) had at least two reasons for changing medication, with lack of efficacy, adverse events and treatment optimisation before reintegration being the most common. Contrary to recommendations, 89% of patients were switched abruptly between medications. A total of 62% of patients received amisulpride doses in the range 400-800 mg/day and most (72%) required no dose adjustment. The great majority of patients (87%) switched to amisulpride without problems.
随着越来越多的新型抗精神病药物问世，制定关于这些药物换药的实用指南变得愈发重要。换药的指征包括患者或其家属/护理人员要求更换药物、患者无法耐受当前治疗、患者患有躯体或精神共病、患者仅部分缓解、对治疗难治或复发的情况。一般来说，交叉减药是最可接受的换药方法，不过在某些情况下，如患者对当前治疗出现严重或急性反应时，可能需要突然停药。换药可能出现的问题包括停药反应风险和精神病症状复发。氨磺必利的药理特性意味着它与其他药物相互作用的可能性相对较低，在停用先前的抗精神病药物时可以开始使用。应根据患者当前症状的目标剂量开始用药。对60例换用氨磺必利治疗的患者进行了一项回顾性问卷调查，以确定更换抗精神病药物患者的特征及其原因。患者从多种抗精神病药物换药，包括传统药物（42%的患者）和非典型药物（58%）。大多数患者（87%）至少有两个换药原因，疗效不佳、不良事件和重新融入前的治疗优化是最常见的原因。与建议相反，89%的患者在药物之间突然换药。共有62%的患者接受的氨磺必利剂量在400 - 800毫克/天范围内，大多数（72%）患者无需调整剂量。绝大多数患者（87%）换用氨磺必利没有问题。
