title: Combined antipsychotic treatment involving clozapine and aripiprazole.
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.
authors.affiliation: Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, University of Heidelberg, Mannheim, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Englisch
authors.forename: Mathias
authors.initials: M
authors.lastname: Zink
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D000068180:Aripiprazole; D003024:Clozapine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D010879:Piperazines / Q000627:therapeutic use*; D011618:Psychotic Disorders / Q000188:drug therapy*; D015363:Quinolones / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D015431:Weight Loss / Q000187:drug effects
chemical_list: D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D000068180:Aripiprazole; D003024:Clozapine