Conference paper

COMBINING ANTIPSYCHOTICS; IS THIS STRATEGY USEFUL?

Jill Christy ; School of Clinical Medicine, University of Cambridge, Cambridge, UK ; St Catharine’s College University of Cambridge, Cambridge, UK
David Burnside ; School of Clinical Medicine, University of Cambridge, Cambridge, UK; Robinson College University of Cambridge, Cambridge, UK
Mark Agius ; Clare College University of Cambridge, Cambridge, UK ; Department of Psychiatry University of Cambridge, Cambridge, UK ; South Essex Partnership University Foundation Trust, Cambridge, UK

Abstract

Antipsychotic drugs are commonly combined in psychiatric practice in an attempt to treat schizophrenia. Such practice is
widespread, despite the lack of explicit endorsement by many of the main regulatory bodies. There are varying rationales behind
combining these potent drugs-either to augment the effect of a drug whose action alone is inadequate for patients with treatment
resistant schizophrenia (TRS), or to improve the side effects seen due to treatment. Augmentations are most frequently observed with
clozapine, a drug reserved for use when other antipsychotic medications have failed. Several drugs have been chosen as adjuvants,
including aripiprazole, sulpiride, amisulpiride and risperidone. A small number of RCTs (randomized controlled trials) have been
performed but, despite this data and numerous case reports showing positive changes in symptomatology, Cochrane reviews of
available studies have been unable to definitively confirm the efficacy of these combinations, frequently citing the need for larger,
longer term, prospective studies.Evidence for benefits of combination therapy on side effects is also inadequate. Some RCTs and case
series have shown they can positively alter side effects due to drugs such as clozapine, e.g. metabolic side effects. However, despite
many of the combinations being relatively well tolerated, there is some evidence they can cause adverse effects of their own. More
evidence is essential as, on the current data alone, it is not possible to make a firm recommendation on the efficacy and safety of
antipsychotic combinations. In addition it is vital that the importance of a fair trial of monotherapy at adequate dosages is reinforced
to clinicians, so that patients are not put onto these relatively unknown treatment strategies unnecessarily.

Keywords

antipsychotic; combination; augmentation; clozapine; aripiprazole; amisulpride; sulpiride; risperidone; schizophrenia; treatment-resistant

Hrčak ID:

265736

URI

https://hrcak.srce.hr/265736

Publication date:

5.11.2014.

Visits: 380 *