I've converted several patients from Zyprexa to Abilify in outpatient.
It's not a safe endeavor, but it's certainly something to consider, especially ifthe patient on Zyprexa is suffering from serious metabolic problems.
I do it slow. At a rate of about up to 5mg at a time per month, and hopefully with a team of people involved such as the patient's family, friends, and group home staff because switching a successful antipsychotic to another one will always involve risk, especially when you're switching from something relatively highly efficacious to something relatively lowly efficacious. I try to involve other people because often-times, when someone gets worse, they don't notice it themselves. I also do it slow so if someone worsens, hopefully it won't be by much and we can reverse-course before it gets real bad.
I always explain the risks and benefits to the patient and let them decide unless they lack capacity, in which case I let an independent person like a guardian, or, if no one else is available, I'll have to make the decision.
So far, I've converted, successfully, probably about 20 patients from Zyprexa to Abilify, and in many of those cases the person did actually better on Abilify I don't think it's because Abilify is somehow more efficacious than Zyprexa. In my opinion, it's not.
I've noticed some dynamics that I believe led to this high success rate. First, many short-term facility doctors know Zyprexa is highly-efficacious, and therefore use it as a first-choice in medicating a psychotic or manic patient. Remember, in a short-term facility, the economics favor getting the patient out ASAP. In many cases, if a patient is there longer than 4 days, the institution loses money. You bet that in these cases, a doctor is supposed to try to get a patient out ASAP, and that directs these doctors to use the big-guns first.
Some doctors also always pull out Zyprexa, without discriminating what is truly the best med for the patient. This is another factor that I believe led to me successfully crossing over several patients.
But in outpatient, if a patient is stable, they could stay in this treatment setting indefinitely--years. You have time to try other meds, and the economics don't work against you to get the patient out ASAP. I definitely think if you have a patient who is having metabolic issues, and having oversedation to try to switch from Zyprexa to another antipsychotic, but only in a controlled manner.
As for the patients who IMHO did better on Abilify, I believe it's because Zyprexa often zonks people out. Abilify often does not have this effect. Most of the patients I've converted often complained of confusion, problems staying awake, and other symptoms of being zonked in one way or another. While someone could've simply attributed that to negative symptoms, I believe it was due to side effects in most of the cases I've seen because like I said, Zyprexa is a more effective antipsychotic than Abilify. How could the less powerful med work better against psychosis in so many patients? IMHO it wasn't really working better, it was simply having less side effects.
In one group home, out of 25 patients, 21 of them were on Zyprexa or Seroquel. I attempted to convert all of them to Abilify or Geodon. Out of the 21, 17 successfully converted, and in the process were just as well or even better (likely due to less sedation), and dropped considerable weight and cholesterol in a beneficial manner.
1 lost weight but in a bad manner. He actually became underweight despite not having an eating disorder. I had to put him back on Zyprexa just so he'd eat enough again. What happened there I don't know. He's not depressed and just has no appetite off of Zyprexa, and even on that med he has poor appetite.
1 person definitely got worse, and after a trial on Abilify, Geodon, Risperdal, even with augmentation (lithium and Depakote) nope, she still didn't do well. Back to Zyprexa.
The other 2, I haven't noticed anything indicating things were better or worse after the switch.
I'd definitely think twice or not do a switch if the person has a history of treatment-resistant psychosis, a history of severe dangerousness while off of meds, and a lack of people who could observe the person during a switch.
In my forensic facility, I've noticed that not too many patients do well on Abilify. While I have no empirical data to back this up, I've noticed that patients ending up on a forensic psychiatric facility are often worse vs other psychotic or manic patients. Remember, these are people manic or psychotic to the point where they're arrested-often as a result of a behavior that's visibly very apparent as mental illness to those not skilled in treating it. In the forensic unit I work, I usually have to pull out the big guns, and even they're often not enough. I do try Abilify or Geodon, if the patient's stabilized, but if it doesn't work, I put them back on what did work.