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Dr Steven M Stahl presents a lecture on switching medications (part 4 of 4)

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Dr Stahl, MD, is a practicing Psychiatrist in Carlsbad, USA, and author of the best-selling textbook, Essential Psychopharmacology. In this fourth and final video of the series on Psychopharmacology he introduces methods for switching medication and discusses the application of pharmacokinetics and pharmacodynamics of common antipsychotics to switching techniques.

The division in the “-pines”, “-dones”, and “-pips” (see video 2) is helpful, as you only need to remember characteristics of ‘three drugs’ when switching, instead of 17. Discusses several examples for switching from a pine to a done. Best to taper in a view weeks, allowing the receptors to reset (except clozapine as that needs 4-8 weeks). Adding a benzodiazepine (short term) can help if loss of sedation could cause problems (pines generally more sedating than dones). In some cases cross-tapering can work best. Additional considerations when also switching method of administration (e.g. between oral and long-acting formulations) are in order. Under-dosing can also be a risk when the new drug e.g. has lower (initial) bioavailability in the brain. Several examples of these situations are discussed.

Suggested further reading:

View the 1st Dr Stahl Presentation here.

Download Dr Stahl's PDF Pocket Guide to Atypical Antipsychotics (Dosing, switching, and other practical information)