Combination of Clozapine and Ziprasidone in Treatment-Resistant Schizophrenia

Abstract

The combined application of clozapine and ziprasidone follows a neurobiologic rationale and appears to be safe and well tolerated without increasing the risk of side effects.

Long-Term Efficacy and Tolerability of Clozapine Combined with Ziprasidone or Risperidone

“…Finally, Honer et al treated groups of 34 patients over a period of eight weeks and reported that the addition of risperidone did not improve the symptoms in patients with severe schizophrenia [20] . Ziprasidone has been added to clozapine in attempts to reduce metabolic side eff ects [19,25] and to optimize antipsychotic effi cacy [39,40] .…”

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

“…51 We identified nine noncontrolled observational trials comparing antipsychotic polypharmacy to monotherapy in samples with established treatment resistance to trials of a single antipsychotic (Table 1). [53][54][55][56][57][58][59][60][61] All studies were of patients with schizophrenia or schizoaffective disorder. Eight of the trials reported significant improvement in reduced symptoms with the addition of a second antipsychotic.…”

“…Eight of the trials reported significant improvement in reduced symptoms with the addition of a second antipsychotic. 53,[55][56][57][58][59][60][61] Of the eight studies that examined side effects, four reported no change with the addition of a concurrent antipsychotic. 53,54,59,60 Three studies reported increased side effects with the addition of another antipsychotic, [56][57][58] whereas one study reported a decrease in sedation.…”

“…Of the nine trials, eight involved clozapine augmentation. [53][54][55][56][58][59][60][61] Clozapine was augmented with risperidone in three studies; 54,56,59 amisulpride (a second-generation drug not available in the United States) in two trials; 53,58 and pimozide 55 , aripiprazole, 60 and ziprasidone 61 each in one trial. The ninth trial reported on the nonspecific use of two SGAs in combination.…”

“…[60][61][62] All three studies were of patients with schizophrenia or schizoaffective disorder. None of the three trials found clinical outcomes from multiple antipsychotics to be significantly better than outcomes from a single antipsychotic.…”