Combined low-dose clozapine with low-dose aripiprazole in a schizophrenic patient

Aripiprazole, a partial dopaminergic agonist, represents a well-tolerated and effective addition to the antipsychotic armamentarium. However, accumulated data indicates that aripiprazole may still induce extrapyramidal side effects (EPS) in susceptible patients. Guidelines for treating schizophrenia have consistently recommended antipsychotic monotherapy. Nevertheless, in certain clinical situations, a thorough evaluation of the benefit/risk ratio suggests that combinations of antipsychotic agents may improve treatment efficacy and tolerability. We report a schizophrenic patient for whom sequential administration of aripiprazole and risperidone induced severe EPS, and subsequent combination therapy with of clozapine and aripiprazole achieved adequate symptom control and markedly reduced EPS.