Tapering/Switching Antipsychotics

Last edited on October 10, 2023

Antipsychotics may be tapered or switched due to clinical reasons. There are no published controlled trials on switching antipsychotics, guidelines therefore are only an aid and not necessarily supported by evidence. The risk of antipsychotic discontinuation is significant in primary psychotic disorders (See: Antipsychotics - Length of Treatment)

See also: Shah, A., Dubey, S., & Das, P. (2015). A medication change, then involuntary lip smacking and tongue rolling. Current Psychiatry, 14(9), 43-48

Withdrawal-emergent dyskinesia (W-ED) are moderate abnormal movements have been reported to occur from antipsychotic withdrawal in persons without a history of persistent tardive dyskinesia.^[1]^[2] This phenonemon is not well studied, and some studies have found an incidence of up to 30% of individuals that discontinue antipsychotics.
W-ED typically occurs within 4 to 6 weeks of antipsychotic discontinuation, and resolves within 1 to 3 months of onset.^[3] Short-term management includes watchful waiting with reassurance in mild cases, while short-term symptomatic treatment includes clonazepam or reintroduction of the same antipsychotic, followed by more gradual taper or cross-taper.

See also: Brandt, L. et al. Adverse events after antipsychotic discontinuation: an individual participant data meta-analysis. The Lancet Psychiatry, Volume 9, Issue 3, 232 - 242

Antipsychotic withdrawal symptoms may include nausea and vomiting, abdominal pain, diarrhea, headache, tachycardia, vertigo, increased perspiration, dry mucous membranes, myalgia, restlessness, anxiety, tension, insomnia, and hyperkinesia.^[4]