Combined antipsychotic treatment involving clozapine and aripiprazole |
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| Authors: | Englisch Susanne Zink Mathias |
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| Affiliation: | Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, University of Heidelberg, Mannheim, Germany. |
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| Abstract: | ![]()
Treatment resistance is considered a challenging problem of antipsychotic pharmacotherapy. In such cases, combination approaches are commonly used, for instance the add-on of aripiprazole to clozapine. This review aims at giving an overview of the present knowledge on this strategy. We performed a keyword-based screening of databases (including November 2007) and evaluated the data in a systematic manner. The courses of 94 patients were reported in 11 publications. At a mean dosage of 20.5 mg/day, aripiprazole achieved clinical improvement of psychotic symptoms and facilitated a dose reduction of clozapine from 476.7 to 425.1 mg/day. In parallel, clozapine serum levels decreased from 611 to 523 ng/ml. No pharmacokinetic interactions were reported, and clozapine-induced side effects ameliorated. However, single cases of extrapyramidal side effects occurred. The combination of clozapine and aripiprazole follows a neurobiological rationale and appears to be effective and tolerable. The results of placebo-controlled trials might allow further insight into the benefits and risks of this strategy. |
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| Keywords: | AIMS, Abnormal Involuntary Movement Scale APZ, Aripiprazole BAS, Barnes Akathisia Scale BPRS, Brief Psychiatric Rating Scale CGI, Clinical Global Impression CLZ, Clozapine CR, case report Y, year m, male M, month MADRS, Montgomery–Asberg Depression Rating Scale MMSE, Mini-Mental State Examination NS, negative symptom SE, side effects OS, open-label studies PANSS, Positive and Negative Syndrome Scale (including positive subscale: “pos.”, negative subscale: “neg.”, and global psychopathology: “GP”) PS, positive symptoms QLS, Quality of Life Scale QoL, Quality of Life QTc, ECG-interval (start of Q-spike to end of T-spike) with frequency correction RCS, retrospective case series SARS, Simpson–Angus Rating Scale D, day ther.-res., therapy-resistant f, female W, week yoa, years of age YBOCS, Yale–Brown-Obsessive–Compulsive-Scale |
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