Revising polypharmacy to a single antipsychotic regimen for patients with chronic schizophrenia

Abstract

Antipsychotic polypharmacy has been empirically used and a recent trend in favour of that mode of therapy has been suggested for the treatment of schizophrenia. The clinical efficacy, however, still remains to be clarified. In order to critically evaluate the usefulness of such kind of psychopharmacotherapy, antipsychotic combination regimen (polypharmacy) was switched to a treatment with the single main antipsychotic (monotherapy) in cross-tapered fashion, while approximately maintaining the total amount, for patients with chronic schizophrenia. Patients had been treated with an average of three antipsychotics and maintained with the same antipsychotic polypharmacy regimen for more than 6 months before the entry. They were followed up with an antipsychotic monopharmacy and evaluated at 24 wk after completion of switching. Forty-seven patients were recruited for this study. Of 44 patients for whom evaluation was possible, 24 (54.5%) remained stable, while 10 (22.7%) showed improvement and the same number of patients ended in a deleterious status. Twenty-two patients were converted to antipsychotic monotherapy, while another 12 needed minimal dosing of low-potency agents. Overall, social functioning, evaluated by the Global Assessment of Functioning and the Clinical Global Impression, remained unchanged. Eighteen of 34 successful patients showed adverse effects of the main antipsychotic medication, which necessitated a significant dose reduction. Nine out of 10 deteriorating patients had been treated with a combination of low- and high-potency antipsychotics. It is suggested that many instances of antipsychotic polypharmacy is avoidable. The result is compatible with the current treatment recommendations, which dictate the use of a single antipsychotic agent.

Antipsychotic polypharmacy: review of mechanisms, mortality and management

“…31 Individuals were often taking three antipsychotic medications and had been doing so for more than 6 months. Of the 44 patients included in the study, 22 (50%) were successfully converted to monotherapy without detriment to their mental health.…”

“…The authors concluded that most cases of multiple antipsychotic use were avoidable and recommended that polypharmacy 'should not be overused and should be the exception, to be used when other therapeutic options have failed'. 31 Suzuki et al also studied patients receiving high-dose antipsychotic polypharmacy without improvement in their symptoms who were switched to second-generation (atypical) antipsychotic monotherapy. 32 Of the 25 individuals recruited into the study, 23 were successfully switched to monotherapy with no detriment to their mental health at the end-point of the study (12 weeks after completion of their switch) and the vast majority showed an improvement in their Global Assessment of Functioning score.…”

When Is Antipsychotic Polypharmacy Supported by Research Evidence? Implications for QI

“…Of the 22 patients on monotherapy, 8 showed symptomatic improvement, whereas symptom levels for the other 14 were unchanged. 80 Dissemination of treatment algorithms alone has not been found to be effective, 16 but Chong et al reported that combining treatment algorithm implementation with periodic audits of algorithm compliance significantly decreased antipsychotic polypharmacy. 19 Thompson et al achieved a modest reduction using a multifaceted approach combining group education, academic detailing, and chart reminders.…”

Esquizofrenia refratária

“…the use of clozapine proved to be more effective than switching to another SGA in patients who have previously not responded to another SGA. 4) Polypharmacy with SGA Polypharmacy in schizophrenia is widespread all over the world 41 despite the fact that there is no evidence of the superiority of this empiricist therapeutic habit over monotherapy. Some consider that combinations of SGA are well tolerated and may be effective for the treatment of RS, while other authors remain more cautious due a lack of well-controlled studies 42 or evidence of harm as, for example, increased mortality.…”

“…Some consider that combinations of SGA are well tolerated and may be effective for the treatment of RS, while other authors remain more cautious due a lack of well-controlled studies 42 or evidence of harm as, for example, increased mortality. 43 In a naturalistic study in seven psychiatric hospitals, Janssen et al 44 found that patients discharged with more than one antipsychotic had significantly poorer outcomes with respect to both mental state and social functioning, while Suzuki et al 41 observed an improvement when patients under antipsychotic polytherapy were switched to monotherapy. 5) Clozapine polypharmacy An incomplete response to clozapine is the persistence of psychotic symptoms despite a trial of clozapine with adequate doses (i.e.…”