This includes consideration of differences in receptor binding affinities, in particular for dopaminergic, serotoninergic, alpha-adrenergic, histaminergic, and muscarinic receptors (Table It is important to note that the greater the differences in receptor binding affinities between pre- and post-switch antipsychotic medications, the more care should be taken when switching.
This is due to the increased risk of side effects or withdrawal symptoms or PD rebound phenomena (Table ).
In addition, a survey conducted in Europe, the Middle East, and Africa suggested that 34% of psychiatrists would consider altering their patient's pharmacotherapy if they believed the patient to have impaired social functioning, while 27% of respondents indicated that switching antipsychotics would be their preferred pharmacological strategy in order to address deficits in social functioning in patients with schizophrenia .
In Europe, consensus guidelines suggest that the initial choice of antipsychotic medication or the decision to switch to a new antipsychotic medication should be made on the basis of individual patient preference, prior treatment response, experience of side effects, adherence history, relevant medical history and risk factors, medication side-effect profile, and long-term treatment planning  of antipsychotic dosing in psychiatric illness reported dosing recommendations and consensus estimates of clinically equivalent doses, including an equivalency ratio for paliperidone ER compared with chlorpromazine and with olanzapine.
Recently diagnosed patients, those with renal impairment, or patients who have previously experienced tolerability issues with other antipsychotics may require lower doses.
When switching from risperidone, higher doses of paliperidone ER may be required compared with risperidone.
This study also reported a number of patient-related factors that may affect these dosing recommendations .
Nevertheless, consensus strategies for switching between different antipsychotic treatments are lacking.
Cross-tapering strategies should be considered as a means of reducing the risk of rebound and withdrawal symptoms.
Schizophrenia is a chronic debilitating illness that negatively impacts upon virtually all aspects of patients' lives.
Discontinuation and frequent switching of antipsychotic medication are common in the treatment of patients with schizophrenia.
Reasons for discontinuing or switching antipsychotic medications can include lack of efficacy  involved 1,492 patients randomized to receive either the oral first-generation antipsychotic (FGA) perphenazine or one of a number of oral second-generation antipsychotics (SGAs) (olanzapine, quetiapine, risperidone, or ziprasidone) for up to 18 months.
When compared with FGAs, SGAs are generally more effective against negative and affective symptoms with a better tolerability profile, particularly with regard to extrapyramidal symptoms (EPS) .