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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].