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Table 3 Managing undesirable/rebound effects at antipsychotic treatment initiation and during the initial switch period

From: Dosing and switching of paliperidone ER in patients with schizophrenia: recommendations for clinical practice

Side effect

Corrective approach or (transient) concomitant medications

Akathisia

Lower dose, slow down switch

Add benzodiazepine, antihistamine, beta-blocker, mirtazapine, gabapentin, low dose of low potency FGA

Mania, psychosis

Slow/reverse down titration of prior antipsychotic, increase new antipsychotic; add benzodiazepine, valproate

Agitation

Slow switch, increase dose of new antipsychotic; add benzodiazepines or low potency FGA, valproate

Anxiety

Use lower starting dose, slow switch, restrict excessive caffeine use, benzodiazepine, antihistamine, antidepressant, gabapentin

Insomnia

Slow switch, restrict excessive caffeine use, add low dose of sedating SGA, benzodiazepine, non-benzodiazepine hypnotic, antihistamine, trazodone

  1. FGA, first-generation antipsychotic; SGA, second-generation antipsychotic. Adapted from [40].