title: Antipsychotic agents used to augment clozapine during long-term inpatient hospitalizations.
abstract: BACKGROUND
  Literature assessing effective clozapine augmentation strategies is limited. The aim of this retrospective evaluation was to examine antipsychotics used to augment clozapine and assess whether an augmentation antipsychotic would continue at discharge.
  
  
  METHODS
  Demographic, clinical and pharmacy data were collected retrospectively if patients had received clozapine plus an antipsychotic used for augmentation. The dose of the augmentation agent, length of augmentation therapy, and concomitant medications were collected.
  
  
  RESULTS
  Of the 49 patients (mean age 45.3±12.1 years), 27 (55%) were male. The mean clozapine dose at discharge was 406.1±121.8 mg. When a first generation antipsychotic (FGA) was selected initially to augment clozapine there was a greater likelihood it would be continued until discharge compared to a second generation antipsychotic (SGA) (78 vs. 50%, OR=3.6, 95% CI 1.03-12.6). FGAs (3.2%) compared to SGAs (35%) were less likely to be discontinued due to a documented lack of benefit when first selected to augment clozapine (OR=16.2, 95% CI 2-131.3). Electroconvulsive therapy plus clozapine was found to be beneficial in several patients (n=14) who failed at least 1 augmentation strategy.
  
  
  CONCLUSIONS
  This real world data suggests that adding an antipsychotic to clozapine is a reasonable approach to those who do not fully respond to clozapine monotherapy. While comparisons of all agents could not be conducted from this small retrospective study, these data suggest FGAs should be investigated in future studies as potential agents to successfully augment clozapine therapy.
authors.affiliation: Department of Hospital Pharmacy Services, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Leung
authors.affiliation: Western Psychiatric Institute and Clinic of UPMC, Department of Psychiatry, University of Pittsburgh School of Medicine, PA USA.
authors.forename: K N R
authors.initials: KN
authors.lastname: Chengappa
authors.affiliation: Western Psychiatric Institute and Clinic of UPMC, Department of Psychiatry, University of Pittsburgh School of Medicine, PA USA.
authors.forename: E
authors.initials: E
authors.lastname: Ivanov
authors.affiliation: Western Psychiatric Institute and Clinic of UPMC, Department of Psychiatry, University of Pittsburgh School of Medicine, PA USA.
authors.forename: G
authors.initials: G
authors.lastname: Gandotra
authors.affiliation: Western Psychiatric Institute and Clinic of UPMC, Department of Psychiatry, University of Pittsburgh School of Medicine, PA USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Kahn
authors.affiliation: Western Psychiatric Institute and Clinic of UPMC, University of Pittsburgh School of Pharmacy, Pittsburgh, PA USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Weber
authors.affiliation: Western Psychiatric Institute and Clinic of UPMC, University of Pittsburgh School of Pharmacy, Pittsburgh, PA USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Fabian
mesh_terms: D000328:Adult; D000367:Age Factors; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003024:Clozapine / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004565:Electroconvulsive Therapy / Q000379:methods; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy* / Q000628:therapy; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine