Benefits and risks of antipsychotic polypharmacy: an evidence-based review of the literature.
Combination antipsychotic prescription is an increasingly common practice in clinical psychiatry. This clinical practice is at odds with clinical guidelines promoting antipsychotic monotherapy. Moreover, there has been increased concern over the safety profile of atypical antipsychotics in the last 10-15 years. We reviewed the literature on antipsychotic combinations with a focus on safety and efficacy. Multiple electronic database searches were complemented by relevant bibliography cross-checking and expert discussions. The review showed a literature that is dominated by case reports and uncontrolled studies. Polypharmacy was unequally studied, with some recent combinations (i.e. clozapine and risperidone) being extensively, albeit inconclusively, studied and other more commonly used combinations (first- with second-generation agents) receiving little attention. From an evidence-based perspective, further trials of antipsychotic association of sufficient power to address safety issues are needed before recommending any antipsychotic combination. Particular weaknesses of the present literature are low number of participants, lack of adequate control of confounding variables, short duration of experimental follow-up and inadequate monitoring of potential adverse effects.
Tranulis
Constantin
C
Fernand-Seguin Research Center, Montreal, Quebec, Canada. constantin_tranulis@hms.harvard.edu
Skalli
Leila
L
Lalonde
Pierre
P
Nicole
Luc
L
Stip
Emmanuel
E
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003625:Data Collection / Q000379:methods / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D010506:Periodicals as Topic; D019338:Polypharmacy; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment / Q000379:methods
D014150:Antipsychotic Agents