title: A framework to avoid irrational polypharmacy in psychiatry.
abstract: Many patients with psychiatric disorders do not obtain remission from available pharmacological and psychotherapeutic treatments. Recent studies have demonstrated that there is a role for the rational use of 'combination therapy' when treating patients with serious and treatment-resistant mental illnesses. When prescribing multiple medications, it is easy, however, to fall into irrational polypharmacy. We present a framework that clinicians can use to avoid the pitfall of irrational polypharmacy. When using combination therapy, clinicians should consider: (a) pharmadynamic redundancy; (b) pharmacodynamic interactions; (c) pharmacokinetic interactions; and (d) avoid inadequate dosing of medications. Clinicians should also (e) regularly reassess the need for and benefit of continued combination therapy.
authors: University of Ottawa Institute for Mental Health Research, Ottawa, ON, Canada.
authors: Daniel
authors: D
authors: Zigman
authors: Pierre
authors: P
authors: Blier
mesh_terms: D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D001523:Mental Disorders / Q000188:drug therapy*; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D011619:Psychotropic Drugs