Medications for best adherence

What is the importance of medication adherence?

One-quarter to one-half of people with schizophrenia do not adhere to their medication. Non-adherence to maintenance treatments, including antipsychotics, is a widespread issue that plagues clinical management for schizophrenia. It reduces the success of the treatment regimen and the ability to achieve remission from illness, but it also increases the burden for psychotic relapse treatments, emergency admissions and hospitalisation. Greater adherence to treatment can contribute not only to more successful disease management and better quality of life, but also to improved attitudes towards treatment and medication, as well as increasing insight and confidence. In controlled clinical trials, drop-out rates can be a proxy measure of the overall tolerability and efficacy of the medication.

What is the evidence for medication adherence?

High quality evidence shows a small to medium-sized effect of lower drop-out rates in trials of flexible dose, second-generation antipsychotics compared to flexible dose, first-generation antipsychotics, with no differences in drop-out rates in trials of fixed doses. Moderate to high quality evidence suggests olanzapine and risperidone showed similar treatment response rates, but olanzapine had lower dropout rates. Moderate quality evidence suggests drop-out rates may be higher in people receiving placebo or first-generation antipsychotics compared to second-generation antipsychotics. Drop-out rates may increase with longer treatment duration.

For specific antipsychotics compared to placebo, moderate to high quality evidence shows there was less all-cause discontinuation with (in order of descending effects, first being best); clopenthixol, amisulpride, olanzapine, paliperidone, thiotixene, thioridazine, clozapine, loxapine, iloperidone, perphenazine, aripiprazole, risperidone, zuclopenthixol, zotepine, asenapine, quetiapine, lurasidone, brexpiprazole, haloperidol, and ziprasidone. There were no differences between placebo and perazine, levomepromazine, flupentixol, molindone, fluphenazine, chlorpromazine, cariprazine, sulpiride, sertindole, penfluridol, trifluoperazine, and pimozide.

October 2020

Image: ©Maksym Yemelyanov –

Last updated at: 4:00 am, 31st August 2021
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