Psychiatria pre prax 1/2022

Rational combinations of antipsychotics in the treatment of schizophrenia

Despite modest support from the therapeutic guidelines, antipsychotics combination in treatment of schizophrenia is more common than we would expect. This fact highlights the rationale of the combination of antipsychotics in certain specific situations of common clinical practice. The results of studies on the efficacy and safety of combination of antipsychotics vary significantly depending on their design. Evidence for combination therapy is found mainly in large cohort studies, which appear to better select patients who may benefit from combination treatment. In any case, it is rational to use a combination of antipsychotics only after an adequate therapeutic trial with clozapine monotherapy and after ruling out pseudoresistance. If we decide to use combination therapy, it is necessary to consider several pharmacodynamic and pharmacokinetic factors that ultimately determine the effectiveness and safety of this therapeutic approach.

Keywords: antipsychotics combination, polypharmacy, schizophrenia, pharmacodynamics, pharmacokinetics