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Antipsychotic polypharmacy in schizophrenia: benefits and risks
Thomas R E Barnes1, Carol Paton
1Division of Experimental Medicine,Centre for Mental Health, Imperial College London, Charing Cross Campus, London, UK. t.r.barnes@imperial.ac.uk
CNS Drugs
|April 12, 2011
Summary
Antipsychotic polypharmacy, using multiple antipsychotic drugs, is common but lacks strong evidence for benefit. This practice increases risks and adverse effects, with limited success in improving patient outcomes.
Area of Science:
- Psychiatry and Pharmacology
- Clinical Practice and Treatment Strategies
Background:
- Antipsychotic polypharmacy, the co-prescription of multiple antipsychotic drugs, is prevalent in psychiatric services, particularly for schizophrenia.
- It is often employed to enhance therapeutic response but lacks robust evidence supporting its efficacy and safety.
- This practice contributes to high-dose prescribing and an increased burden of adverse effects.
Purpose of the Study:
- To review clinical trial data and evidence regarding the risks and benefits of antipsychotic polypharmacy.
- To examine various reasons for its use, including therapeutic augmentation, managing disturbed behavior, and switching medications.
- To assess interventions aimed at reducing the prevalence of antipsychotic polypharmacy.
Main Methods:
- Review of existing clinical trial data and other relevant evidence on antipsychotic polypharmacy.
- Analysis of systematic, practice-based interventions designed to decrease antipsychotic polypharmacy.
- Examination of guidelines regarding the use of combined antipsychotics for refractory psychotic illness.
Main Results:
- Evidence supporting the benefits of antipsychotic polypharmacy is equivocal and generally insufficient for routine clinical recommendation.
- Common uses include boosting response, managing agitation, medication switching, and clozapine augmentation, with varying degrees of justification.
- Interventions to reduce polypharmacy have shown only modest success.
Conclusions:
- Antipsychotic polypharmacy should be reserved for refractory psychotic illness after exhausting evidence-based treatments like clozapine.
- Prescription requires individual trials with close monitoring of clinical response, adverse effects, and physical health.
- Current evidence does not adequately support the routine use of antipsychotic polypharmacy due to its associated risks and limited proven benefits.
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