Switching Medications

Special precautions are necessary when switching from one medication to another. There are several methods a physician may use when switching medications. The method chosen will depend on the type of medication involved, what it is being used for, the reason for switching, and the severity of a patient?s symptoms at the time of change. Each method has its own strengths and weaknesses. It is important during a switch-over period to work closely with your healthcare provider and to report any side effects or symptoms you experience. When switching medications, following your healthcare provider's instructions can help you avoid serious drug interactions and unnecessary delays in treatment.

• Washout/start
• Stop/start
• Cross-taper
• Delayed withdrawal

Washout/start - A washout period is a period of time taken to slowly withdraw a medication followed by a few days to make sure all the medication has left the body. Only after the first medication has left the body will the new medication be started. This is not the method chosen when symptoms are severe. Although most medications completely leave the body after a few days, some medications may even require a few weeks.

Stop/start - With this method one medication is stopped abruptly and the second medication started immediately. This method works well if there are no interactions between the old and new medications, and if the new medication will prevent the withdrawal effects of the medication being stopped.

Cross-taper - A cross-taper refers to a slow decrease in the dose of one medication, while slowly increasing the second medication. This method may be used if there are no serious drug interactions between the two medications. When using this method one would hope the actions of the two medications would compliment each other so that the patient would always have full medication protection. However, not all medications have additive effects, so another method may need to be chosen.

Delayed Withdrawal - This is when a patient is stabilized on an effective dose of the new medication before beginning to withdraw the medication that is being replaced. It is important that there not be any interactions between the two medications and that the patient keeps their healthcare provider aware of any side effects and symptoms they experience.