Polypharmacy

What is polypharmacy?

Polypharmacy is combined pharmaceutical treatment that is used for patients who are unresponsive or partially responsive to single therapies.

What is the evidence for polypharmacy?

Any combination therapy vs. any monotherapy or placebo;

Moderate quality evidence suggests fewer relapses with combination therapy than with monotherapy or placebo. The risk of relapse is highest in the first year of treatment.

Antipsychotic olanzapine + antidepressant fluoxetine vs. placebo, olanzapine or anticonvulsant lamotrigine;

Moderate to high quality evidence suggests greater improvement in depression with combined olanzapine + fluoxetine therapy.

Second-generation antidepressants + mood stabilisers or antipsychotics vs. placebo + mood stabilisers or antipsychotics;

Moderate to high quality evidence suggests adjunctive second generation antidepressants were associated with a small effect of greater improvement in depression in the short-term (< 12 weeks). However, there was an increased risk of switching to mania/hypomania in the longer term (~52 weeks).

Mood stabilisers + antipsychotics vs. mood stabilisers;

Moderate to high quality evidence suggests mood stabilisers + antipsychotics resulted in small effects of greater response and remission, and improved mania and depression. However, there were increased rates of discontinuation due to adverse effects with adjunctive antipsychotics, in particular, more sleepiness, somnolence, weakness, faintness, dizzyness, appetite, weight gain, tremor, use of antiparkinsonian drugs, dry mouth and thirst, and changes in triglycerides, fasting glucose, and HbA1c levels.

Mood stabilisers + antipsychotics vs. antipsychotics;

Moderate quality evidence suggests mood stabilisers + antipsychotics resulted in small effects of better response and remission, and improved mania, but not depression. However, there were medium-sized to large effects of more tremor, sleepiness, and vomiting.

March 2019

Last updated at: 6:46 am, 1st April 2019
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Title Colour Legend:
Green - Topic summary is available.
Orange - Topic summary is being compiled.
Red - Topic summary has no current systematic review available.