Combination of ziprasidone and clozapine in treatment‐resistant schizophrenia

Zink, Mathias; Mase, E.; Dreßing, Harald

doi:10.1002/hup.580

Cited by 24 publications

(8 citation statements)

References 10 publications

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“…Though several reports from smaller trials provide evidence to support the potential effectiveness of antipsychotic polytherapy for patients with treatment-resistant disease, 21,22,34 no atypical antipsychotic has gained FDA approval for use in combination with other atypicals. Furthermore, the American Psychiatric Association' s treatment guidelines for schizophrenia 30 do not support the use of polytherapy as routine practice.…”

Section: Ss Discussionmentioning

confidence: 99%

Prescribing of Antipsychotic Medication in a Medicaid Population: Use of Polytherapy and Off-Label Dosages

Kogut¹,

Yam²,

Dufresne³

2005

JMCP

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Section: Ss Discussionmentioning

confidence: 99%

Prescribing of Antipsychotic Medication in a Medicaid Population: Use of Polytherapy and Off-Label Dosages

Kogut¹,

Yam²,

Dufresne³

2005

JMCP

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“…Beneficial effects of ziprasidone co-administration to clozapine have been reported in a small number of patients, both in open trials (Kaye, 2003;Ziegenbein, et al, 2005) and case reports (Ziegenbein and Calliess, 2006;Zink, et al, 2004bZink, et al, , 2004c.…”

Section: Introductionmentioning

confidence: 95%

Efficacy and tolerability of ziprasidone versus risperidone as augmentation in patients partially responsive to clozapine: a randomised controlled clinical trial

et al. 2008

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Patients suffering from schizophrenic psychoses sometimes insufficiently respond to antipsychotic monotherapy and then combination approaches are preferred. We aimed in validating the add-on of ziprasidone and risperidone to clozapine, and we performed a randomised head-to-head trial. Patients with partial response to clozapine were randomly attributed to augmentation with ziprasidone (n = 12) or risperidone (n = 12). Efficacy assessments included the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Negative Symptoms (SANS), the Hamilton Depression Scale (HAMD), the Clinical Global Impression (CGI) and the Global Assessment of Functioning (GAF). Furthermore, several safety and tolerability measures were obtained. After six weeks, both groups showed significant reductions of positive and negative symptoms. In addition, affective state, psychosocial functioning and clozapine side effects improved without significant differences between the groups. Both approaches were well tolerated. However, the ziprasidone group experienced a small elongation of the QTc interval and a reduction of extrapyramidal symptoms. Patients under clozapine-risperidone therapy developed a rise of serum prolactin levels. The clozapine augmentation with ziprasidone or risperidone resulted in significant psychopathological improvements. The side effects differed between the treatment groups. Further head-to-head comparisons of atypical antipsychotics as add-on to clozapine are necessary.

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“…Similarly, as in the case of quetiapineaugmentation, it will have to be tested, whether and to which extent the psychopathological changes are consequences due to reduced clozapine side effects or of a specific ziprasidone action. In contrast, in two of the authors' case reports [66,67], minimal possible clozapine doses were used and specific augmentation effects could be observed. Future investigations will have to compare the aforementioned approach with clozapine monotherapy using minimal doses.…”

Section: Combination Of Clozapine and Ziprasidonementioning

confidence: 52%

Augmentation of Clozapine with Atypical Antipsychotic Substances

Dressing¹

2005

CPSR

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The clinical outcome of patients suffering from schizophrenic psychoses has been considerably improved with typical antipsychotic drugs, however, up to 40 % of the cases show treatment resistant symptoms. Even therapy with atypical substances such as risperidone, olanzapine, quetiapine, sulpiride, amisulpride, and ziprasidone often fails in reaching complete remission due to resistant schizophrenic symptoms or dose-limiting side effects. As this also holds true for monotherapy with clozapine, a substance with proved efficacy in formerly resistant cases, increasing numbers of patients receive atypical antipsychotic drugs in addition to clozapine.This review systematically evaluates case reports and clinical investigations on the combined application of clozapine with other atypical antipsychotic drugs. Details about indication, methodology and effects of the investigations are summarized.Only one double blind, placebo-controlled trial on the combination with sulpiride was found in a total number of 34 publications, encompassing a total of 1250 patients. Favorable effects on psychotic symptoms or improvements of clozapine-induced side effects were described for every combination approach. In some cases, pharmacokinetic interactions or serious unfavorable effects were reported.In conclusion, most of the combination therapies follow a neurobiological rationale. There are major differences in the level of evidence regarding their safety, tolerability and effectiveness. We discuss criteria for the indication of a clozapine augmentation and differential indication for existing alternatives. Additional randomized prospective trials are needed in order to systematically evaluate these strategies.

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Combination of ziprasidone and clozapine in treatment‐resistant schizophrenia

Cited by 24 publications

References 10 publications

Prescribing of Antipsychotic Medication in a Medicaid Population: Use of Polytherapy and Off-Label Dosages

Prescribing of Antipsychotic Medication in a Medicaid Population: Use of Polytherapy and Off-Label Dosages

Efficacy and tolerability of ziprasidone versus risperidone as augmentation in patients partially responsive to clozapine: a randomised controlled clinical trial

Augmentation of Clozapine with Atypical Antipsychotic Substances

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