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 suggests a small effect of less discontinuation for any reason, and moderate quality evidence suggests better clinical response with antipsychotic polypharmacy versus monotherapy.

Moderate quality evidence suggests antipsychotic polypharmacy is most often associated with the use of first generation antipsychotics, inpatient status, and a diagnosis of schizophrenia. Polypharmacy use has been higher in Asia and Europe than in North America and Oceania.

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.

March 2019

Last updated at: 3:14 am, 1st April 2019
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