Inheriting patients on two antipsychotics

[sweetlenovo88]

I am working with an SMI population at CMHC and some have been stable on two antipsychotics from the previous provider. I have experimented tapering them to one in the past but a couple patients have destabilized as a result. I used to always taper to one no matter what but am I now becoming more lenient in my policy.

Any thoughts?

---

Members don't see this ad.

 

[Shikima]

I have seen this quite a lot for poorly diagnosed reasons.

 

[SeniorWrangler]

How quick did you taper? It can be hard to distinguish discontinuation syndromes from symptom recurrence.

 

[clausewitz2]

Was one of the antipsychotics always clozapine? I think everyone is owed at least one trial of clozapine if they are to this point long term.

 

[Shikima]

Was one of the antipsychotics always clozapine? I think everyone is owed at least one trial of clozapine if they are to this point long term.

I saw Risperdal LAI and Seroquel for borderline symptoms. The others were legitimate with combining SGAs for schizophrenia, low dosages and doing well.

 

[JustAGuy]

Adding more medications adds more risk. Do the benefits outweigh the risks? Is prescribing multiple antipsychotics the least risky method to obtain these benefits? In the case of a bad outcome from this off-label use of antipsychotics, would it be more likely to lead to a lawsuit than the same poor outcome using the medication for treatment resistant psychosis that is recommended by most consensus guidelines?

 

[thoffen]

Despite the guidelines suggesting limiting of dual antipsychotic usage, the data doesn't clearly show a serious increase in risk. It doesn't show benefit, either. So I would rarely consider initiating dual antipsychotic therapy. If I were inheriting a patient with good clinical response and absence of clear harm, though, I would not be quick to change the treatment. If it wasn't working, causing problems, or any antipsychotic therapy wasn't clearly indicated, this would be a different calculus.