Sulpiride augmentation in people with schizophrenia partially responsive to clozapine

Abstract

A subgroup of patients with chronic schizophrenia may substantially benefit from sulpiride addition to clozapine.

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

“…[47][48][49][50][51][52] All studies were of patients with schizophrenia or schizoaffective disorder. Two studies found that patients on multiple antipsychotics, compared with patients on a single antipsychotic, experienced greater improvement in the primary clinical outcome (that is, symptoms or functioning).…”

“…Two studies found that patients on multiple antipsychotics, compared with patients on a single antipsychotic, experienced greater improvement in the primary clinical outcome (that is, symptoms or functioning). 50,52 Three trials found no difference in the primary clinical outcome between patients on single and multiple antipsychotics. 48,49,51 One trial reported better clinical outcomes for patients on a single antipsychotic.…”

“…47 Four of the six trials reported comparatively greater side effects for patients on multiple antipsychotics, whereas two found no differences in side effects. [47][48][49]52 One trial reported that risperidone augmentation of clozapine worsened verbal working memory, while this outcome improved in the group that remained on a single antipsychotic. 47 The RCTs had small sample sizes (16-68 patients), were relatively brief (lasting from 6 to 12 weeks), and focused on a narrow selection of antipsychotics.…”

“…Five of the six trials examined antipsychotic augmentation of clozapine. [47][48][49][50]52 In four trials, the augmenting agent was risperidone, [47][48][49][50] whereas in the fifth it was sulpiride 52 , an SGA not available in the United States. The sixth trial compared the combination of olanzapine and sulpiride with olanzapine monotherapy.…”

Treatment–Refractory Schizophrenia

“…The data derive mostly from case reports and open studies indicating improved efficacy of clozapine treatment following the addition of risperidone, [116][117][118][119][120][121][122] olanzapine, 123 or typical agents, such as pimozide and sulpiride. [124][125][126] However, the rationale behind this strategy remains elusive and the supportive data are doubtful. Selecting polypharmacy regimens according to specific symptoms or on the basis of a putative mechanism of action is way ahead of the current state of basic knowledge of schizophrenia pathophysiology and the recognized mechanism of action of drugs.…”