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TOP統合失調症および関連する精神病抗精神病薬の副作用抗精神病薬の切り替え

抗精神病薬の切り替え

忍容性不良が理由で抗精神病薬を切り替える際の推奨を以下に要約する。

副作用 最初に推奨される薬剤 代替の薬剤
急性EPS1–8
ジストニア，パーキンソニズム，動作緩慢		 アリピプラゾール
ブレクスピプラゾール
cariprazine
オランザピン
クエチアピン		 クロザピン
ルラシドン
ziprasidone
アカシジア2, 9, 10 オランザピン
クエチアピン		 クロザピン
ブレクスピプラゾール
脂質異常症7, 8, 11–16 amisulpride
アリピプラゾール§
ルラシドン
ziprasidone		 アセナピン
ブレクスピプラゾール
cariprazine
耐糖能異常7, 8, 15, 17–21 amisulpride
アリピプラゾール§
ルラシドン
ziprasidone		 ブレクスピプラゾール
cariprazine
ハロペリドール
高プロラクチン血症7, 8, 15, 22–28 アリピプラゾール§
ブレクスピプラゾール
cariprazine
ルラシドン
クエチアピン		 クロザピン
オランザピン
ziprasidone
起立性低血圧8, 15, 29 amisulpride
アリピプラゾール
ブレクスピプラゾール
cariprazine
ルラシドン		 ハロペリドール
スルピリド
trifluoperazine
QT延長27, 30–37 ブレクスピプラゾール
cariprazine
ルラシドン
パリペリドン		 QT延長で禁忌とならない薬剤の単剤少量投与（ECGモニタリング下）
鎮静7, 8, 27 amisulpride
アリピプラゾール
ブレクスピプラゾール
cariprazine
リスペリドン
スルピリド		 ハロペリドール
trifluoperazine
ziprasidone
性機能障害8, 38–44 アリピプラゾール
ブレクスピプラゾール
cariprazine
ルラシドン
クエチアピン 		クロザピン
遅発性ジスキネジア45–49 クロザピン アリピプラゾール
オランザピン
クエチアピン
体重増加16, 35, 37, 50–57 amisulpride
アリピプラゾール§
ブレクスピプラゾール
cariprazine
ハロペリドール
ルラシドン
ziprasidone		 アセナピン
ハロペリドール
trifluoperazine

§アリピプラゾールへの切り替え，あるいは併用により，体重の減少，血漿中プロラクチン濃度の低下，脂質プロファイルの改善，血糖値の低下が認められるというエビデンスがある58–61。

lumateperoneおよびpimavanserinは使用が限られているため，表には記載していない。いずれもEPSEまたはアカシジアをほとんどあるいは全く引き起こさず，プロラクチンや血圧に影響を与えず，わずかな体重増加と代謝障害をもたらす62, 63。pimvanserinはQTを延長させるが64，lumateperoneはECGに影響しないようである65。

（水島　仁）

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