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Combination of clozapine and amisulpride in treatment-resistant schizophrenia--case reports and review of the literature.
Pharmacopsychiatry. 2004 Jan; 37(1):26-31.P

Abstract

BACKGROUND

The clinical outcome of patients suffering from schizophrenic psychoses has been considerably improved by atypical antipsychotics like clozapine and amisulpride. In patients whose symptomatology cannot be ameliorated by monotherapy, it might be necessary to combine two atypical antipsychotics. While clozapine interacts with a variety of neurotransmitter receptors, amisulpride predominantly binds with high affinity to D3/D2-dopamine receptors. Combination can be considered if a supplementary dopamine-receptor blockade is desired.

METHODS

We report on the therapy of 15 patients using a combination regimen of amisulpride and clozapine. Data were collected from patient records. The case reports document previous treatment attempts, describe the reason for the combination therapy, and determine its effect.

RESULTS

Major (six cases) or at least marked (eight cases) improvement of previously treatment-resistant positive and negative symptoms could be achieved by using a mean clozapine dose of 375 mg/day (serum level 0.38 mg/l) and an amisulpride dose of 527 mg/day. Additionally, by reducing the clozapine dose compared to monotherapy by 24 %, a significant reduction of side effects was observed.

CONCLUSIONS

The combination of amisulpride with clozapine considerably enriches the therapeutic arsenal in cases of severe schizophrenic psychoses. Additional prospective studies are needed in order to systematically evaluate this new treatment strategy.

Authors+Show Affiliations

Central Institute of Mental Health, Mannheim, Germany. zink@kv.zi-mannheim.deNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

14750045

Citation

Zink, Mathias, et al. "Combination of Clozapine and Amisulpride in Treatment-resistant Schizophrenia--case Reports and Review of the Literature." Pharmacopsychiatry, vol. 37, no. 1, 2004, pp. 26-31.
Zink M, Knopf U, Henn FA, et al. Combination of clozapine and amisulpride in treatment-resistant schizophrenia--case reports and review of the literature. Pharmacopsychiatry. 2004;37(1):26-31.
Zink, M., Knopf, U., Henn, F. A., & Thome, J. (2004). Combination of clozapine and amisulpride in treatment-resistant schizophrenia--case reports and review of the literature. Pharmacopsychiatry, 37(1), 26-31.
Zink M, et al. Combination of Clozapine and Amisulpride in Treatment-resistant Schizophrenia--case Reports and Review of the Literature. Pharmacopsychiatry. 2004;37(1):26-31. PubMed PMID: 14750045.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combination of clozapine and amisulpride in treatment-resistant schizophrenia--case reports and review of the literature. AU - Zink,Mathias, AU - Knopf,Udo, AU - Henn,Fritz A, AU - Thome,Johannes, PY - 2004/1/30/pubmed PY - 2004/8/3/medline PY - 2004/1/30/entrez SP - 26 EP - 31 JF - Pharmacopsychiatry JO - Pharmacopsychiatry VL - 37 IS - 1 N2 - BACKGROUND: The clinical outcome of patients suffering from schizophrenic psychoses has been considerably improved by atypical antipsychotics like clozapine and amisulpride. In patients whose symptomatology cannot be ameliorated by monotherapy, it might be necessary to combine two atypical antipsychotics. While clozapine interacts with a variety of neurotransmitter receptors, amisulpride predominantly binds with high affinity to D3/D2-dopamine receptors. Combination can be considered if a supplementary dopamine-receptor blockade is desired. METHODS: We report on the therapy of 15 patients using a combination regimen of amisulpride and clozapine. Data were collected from patient records. The case reports document previous treatment attempts, describe the reason for the combination therapy, and determine its effect. RESULTS: Major (six cases) or at least marked (eight cases) improvement of previously treatment-resistant positive and negative symptoms could be achieved by using a mean clozapine dose of 375 mg/day (serum level 0.38 mg/l) and an amisulpride dose of 527 mg/day. Additionally, by reducing the clozapine dose compared to monotherapy by 24 %, a significant reduction of side effects was observed. CONCLUSIONS: The combination of amisulpride with clozapine considerably enriches the therapeutic arsenal in cases of severe schizophrenic psychoses. Additional prospective studies are needed in order to systematically evaluate this new treatment strategy. SN - 0176-3679 UR - https://www.unboundmedicine.com/medline/citation/14750045/Combination_of_clozapine_and_amisulpride_in_treatment_resistant_schizophrenia__case_reports_and_review_of_the_literature_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2004-815471 DB - PRIME DP - Unbound Medicine ER -