Switching antipsychotic medication to aripiprazole: position paper by a panel of Italian psychiatrists

Abstract

Introduction: Patients with schizophrenia or bipolar disorder treated with antipsychotic medication can frequently experience lack of efficacy and persistent side-effects, so much so that switching from one antipsychotic to another with a different side-effect profile has become a recommended strategy for improving the tolerability and safety of long-term antipsychotic treatment. Aripiprazole is an atypical antipsychotic with proven efficacy in schizophrenia and bipolar I disorder, with a pharmacological profile distinct from other available antipsychotics and a side-effect profile that is different from other agents in the class; these characteristics make it a possible alternative in patients requiring a change in antipsychotic treatment due to lack of efficacy or persistent side-effects.

Areas covered: A panel of Italian experts in psychiatry met to discuss the appropriateness of current strategies for the switch to aripiprazole in patients with schizophrenia or bipolar disorder once a clinician has decided to adopt this choice and also to propose alternate strategies where required. The strategies for the switch to aripiprazole presented in this position paper consider various scenarios encountered in clinical practice, highlight the importance of tapering the prior antipsychotic based on its pharmacological characteristics and provide detailed guidance throughout the entire switching process. Literature searches were conducted using the PubMed database and the search strategy (aripiprazole and switching); additional references were added from the reference lists of the papers obtained and also from the authors’ knowledge of the topic.

Expert opinion: Few studies have addressed the indications for antipsychotic switching and the best practical strategies to achieve the desired goal in the clinical practice setting. Studies on antipsychotic switching should clarify why, when and how a switch should be done. The results should standardize the reasons for switching an antipsychotic, assess the optimal time to switch and evaluate the best ways to switch. Both clinical and pharmacological factors should be considered when a patient needs to switch antipsychotics, and specific guidelines for antipsychotic switching that address all these factors are needed.

Keywords:

• antipsychotics
• aripiprazole
• bipolar I disorder
• schizophrenia
• switching

Declaration of interest

A Fagiolini is/has been a consultant and/or a speaker and/or has received grants from Angelini, Astra Zeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Janssen, Lundbeck, Novartis, Otsuka, Pfizer, Roche and Takeda. R Brugnoli is/has been a consultant and/or a speaker and/or has received grants from Angelini, Innova, Eli Lilly, Lundbeck, Otsuka and Pfizer. G Di Sciascio is/has been a consultant and/or a speaker and/or has received grants from Angelini, Astra Zeneca, Bristol-Myers Squibb, Eli Lilly, Janssen-Cilag, Lundbeck, Otsuka and Polifarma. G Maina is/has been a consultant and/or a speaker and/or has received grants from Astrazeneca, Lundbeck, Janssen-Cilag, Otsuka, Stroder and Pfizer. S De Filippis has been a consultant for Otsuka. Medical writing assistance was utilized in the preparation of this paper; it was carried out by S Henness, of Springer Healthcare Communications, and L Lanini on behalf of Springer Healthcare Communications with the unconditional support of Otsuka Pharmaceutical Italy S.r.l. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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