Antipsychotic polypharmacy

What is antipsychotic polypharmacy?

Antipsychotic combination treatment, also called antipsychotic polypharmacy, has been utilised in clinical practice for patients who are unresponsive or partially responsive to antipsychotic monotherapies. Please also see the treatments for medication-resistant schizophrenia topic for augmentation with other pharmaceutical agents.

What is the evidence for antipsychotic polypharmacy?

Moderate to high quality evidence finds a medium-sized improvement in overall symptoms, and a small improvement in clinical response with antipsychotic polypharmacy compared to monotherapy, particularly in studies using clozapine or other second-generation antipsychotics. However, the benefit for symptoms were only apparent in poor quality trials.

High quality evidence finds a small effect of less discontinuation for any reason with antipsychotic polypharmacy.

For people with insufficient response to antipsychotic treatment, moderate quality evidence suggests augmenting clozapine with aripiprazole may provide some improvement in overall symptoms. Aripiprazole augmentation may result in less weight gain and lower LDL-cholesterol than placebo, but may result in more akathisia, agitation and anxiety. There may be no improvements after augmentation with risperidone. Low quality evidence is unable to determine the benefit of augmentation with other antipsychotics for people with treatment-resistant schizophrenia.

October 2019

Last updated at: 3:12 am, 4th October 2019
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