Korean J Psychopharmacol.  2013 Oct;24(4):137-146.

Recent Trends of Antipsychotics Polypharmacy in Schizophrenia

• Chang JG
• Roh D
• Kim CH

Abstract

Antipsychotics polypharmacy is a common practice in clinical settings despite the opposition of most guidelines for treatment of schizophrenia. This article reviews the evidence of antipsychotics polypharmacy and summarizes advantages and disadvantages shown in clinical trials. Clinicians choose antipsychotics polypharmacy to control the positive and negative symptoms more effectively especially in treatment resistant patients or to reduce adverse effects. There are some theoretical possibilities that antipsychotics polypharmacy affects a broader range of receptors, enhances D2-receptor blockade and optimizes pharmacokinetic effects. Clinical evidence suggests that clozapine co-administered with risperidone, sulpiride, or amisulpride reduces psychotic symptoms in treatment-resistant patients and that aripiprazole with other antipsychotics reduces metabolic side effects. On the other hand, antipsychotics polypharmacy is associated with problems such as dose-dependent side effects, metabolic problems, increased mortality and treatment cost. Considering pros and cons, antipsychotics polypharmacy must be started after close scrutiny of the patient's medication history not just by clinical judgment. Also, changing the regimen from polypharmacy to monotherapy should be considered as a reasonable option to schizophrenic patients in stationary status.

Keyword

Antipsychotics; Polypharmacy; Schizophrenia

MeSH Terms

Antipsychotic Agents*
Clozapine
Hand
Health Care Costs
Humans
Judgment
Mortality
Piperazines
Polypharmacy*
Quinolones
Risperidone
Schizophrenia*
Sulpiride
Aripiprazole
Antipsychotic Agents
Clozapine
Piperazines
Quinolones
Risperidone
Sulpiride