Reduction of Side Effects by Combining Clozapine with Amisulpride: Case Report and Short Review of Clozapine-Induced Hypersalivation

Croissant, Bernhard; Hermann, Derik; Olbrich, Robert

doi:10.1055/s-2005-837771

Cited by 31 publications

(19 citation statements)

References 8 publications

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“…Some authors reported that clinical efficacy could be maintained after augmenting clozapine therapy with amisulpride and lowering daily doses of clozapine, thereby reducing common side-effects such as sedation, hypersalivation and weight gain (Croissant et al, 2005;Cook and Hoogenboom, 2004;Zink et al, 2004). To the best of our knowledge, the present study is the first prospective randomized double-blind, placebo-controlled cross-over study of the beneficial effects of short-term amisulpride augmentation (400 mg/day) of stable ongoing clozapine therapy in the reduction of CIH.…”

Section: Discussionmentioning

confidence: 96%

Amisulpride treatment of clozapine-induced hypersalivation in schizophrenia patients: a randomized, double-blind, placebo-controlled cross-over study

Kreinin¹,

Novitski²,

Weizman³

2006

International Clinical Psychopharmacology

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The beneficial effect of sulpiride augmentation of clozapine therapy for treatment-resistant schizophrenia patients is enhanced by its antisalivatory effect on clozapine-induced hypersalivation (CIH). Amisulpride, similar to sulpiride, is a substitute benzamide derivative with higher selective binding to the D2/D3 dopamine receptor. We hypothesized that add-on amisulpride would also be beneficial in controlling CIH. In a randomized, double-blind, placebo-controlled cross-over study, 20 clozapine-treated schizophrenia (DSM-IV criteria) inpatients with CIH were randomly initially assigned to add-on amisulpride (nine patients; 400 mg/day up-titrated from 100 mg/day over 1 week) or placebo (11 patients). Primary outcome was change in the five-point Nocturnal Hypersalivation Rating Scale (NHRS). Other measures included the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression scale (CGI) and Simpson-Angus Scale (SAS). Mean NHRS indices were considerably lower with amisulpride (1.79 +/- 1.25) than with placebo (2.63 +/- 1.33) [F(1,38) = 5.36, P < 0.05]. With amisulpride treatment, there was a significant improvement on the negative symptoms subscale of the PANSS [F(3,57) = 3.76, P < 0.05], but not on the SAS, CGI or other subscales of the PANSS (all F < 1). Short-term amisulpride augmentation has a strong ameliorating effect on CIH. A long-term, large-scale study with a broader dose range is warranted to evaluate the stability of this effect across time.

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Section: Discussionmentioning

confidence: 96%

Amisulpride treatment of clozapine-induced hypersalivation in schizophrenia patients: a randomized, double-blind, placebo-controlled cross-over study

Kreinin¹,

Novitski²,

Weizman³

2006

International Clinical Psychopharmacology

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“…If symptoms emerge following dose reduction, supplementation with other drugs may improve antipsychotic efficacy without causing sialorrhea. In a single case study, amisulpiride added to clozapine decreased its requirement and reduced troublesome sialorrhea (Croissant et al 2005).…”

Section: Management Strategiesmentioning

confidence: 99%

Clozapine-induced sialorrhea: pathophysiology and management strategies

2006

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Rationale: Clozapine is an atypical antipsychotic agent with proven efficacy in refractory schizophrenia, but its widespread use is limited by adverse effects such as agranulocytosis, seizures, sedation, weight gain, and sialorrhea. Clozapine-induced sialorrhea (CIS) is bothersome and has socially stigmatizing adverse effects, which result in poor treatment compliance. The pathophysiology of this condition is poorly understood and the treatment options available are based mostly on case reports and open-label studies. Objective: To review the available studies on CIS. Method: All relevant studies available through PUBMED search supplemented with manual search were undertaken. Result: The clinical features, complications, assessment, pathophysiology, and management of CIS are discussed. Conclusion: Although the studies evaluating the therapeutic options has limitations and no drug has been found to be superior, judicious use of pharmacological agents along with behavioral methods will reduce this troublesome side effect and enhance compliance.

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“…The atypical antipsychotic amisulpride is effective in the treatment of positive, negative, and depressive symptoms of schizophrenia and has low propensity for extrapyramidal symptoms and weight gain [6,21,31,32]. Accordingly, amisulpride has been repeatedly recommended for combination with other atypical antipsychotics in treatment-resistant patients [5,20]. Pronounced prolactin elevations associated with the D2 antagonistic properties of amisulpride, especially in women [9,11,28,37], may lead to unwanted clinical symptoms [17,27,39].…”

mentioning

confidence: 99%

Gender Aspects in the Clinical Treatment of Schizophrenic Inpatients With Amisulpride: A Therapeutic Drug Monitoring Study

Müller¹,

Регенбоген²,

Sachse³

et al. 2006

Pharmacopsychiatry

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Reduction of Side Effects by Combining Clozapine with Amisulpride: Case Report and Short Review of Clozapine-Induced Hypersalivation

Cited by 31 publications

References 8 publications

Amisulpride treatment of clozapine-induced hypersalivation in schizophrenia patients: a randomized, double-blind, placebo-controlled cross-over study

Amisulpride treatment of clozapine-induced hypersalivation in schizophrenia patients: a randomized, double-blind, placebo-controlled cross-over study

Clozapine-induced sialorrhea: pathophysiology and management strategies

Gender Aspects in the Clinical Treatment of Schizophrenic Inpatients With Amisulpride: A Therapeutic Drug Monitoring Study

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