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changing physicians' orders for specific atypical antipsychotics to Risperdal.

154.

Defendant Janssen's illegal market share kickbacks caused dangerous across-the-

board switching without regard to the patients' track record with their currently prescribed

antipsychotic. It is medically inappropriate to switch antipsychotic therapy if the patient has had

a productive response to a conventional agent, if the patient has recently recovered from an acute

psychotic episode and is on the same medication successfully used to treat that episode, or if the

patient was recently noncompliant with oral medication and is now compliant with a non-orally-

administered antipsychotic. Switching such patients to a different medication can result in loss

of control of the condition, hospitalization, and other adverse outcomes.

ISS.

Switching antipsychotics is, to some extent, even more dangerous than switching

medications within other therapeutic classes, because sudden switches can be extremely

detrimental to patient wellbeing. Janssen implemented this automatic switching scheme despite

the fact that no medically-recognized method to suddenly interchange antipsychotic drugs exists

  • -

    a fact Janssen acknowledges:

There is no systematically collected data to specifically address switching schizophrenic patients from other antipsychotics to RISPERDAL or concomitant administration with other antipsychotics. While immediate discontinuation of the previous antipsychotic may be acceptable for some schizophrenic patients, more gradual discontinuation may be most appropriate for others.

Risperdal package insert.

156.

The

latter

approach

of gradual

discontinuation,

known

as

"drug

tapering,"

has

emerged

as

the

preferred

switching

method.

Yet

there

is

no

"equation"

for

drug

tapering.

Rather, it is a complex process requiring patient-specific analysis to maintain the delicate balance

of gradual tapering of the current medication while the new medication is ramped up until the

patient

is

completely

weaned

off

the

original

medication.

By

incentivizing

Omnicare

with

42

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