Psychiatria pre prax 3/2025
Early dose escalation of lurasidone as part of combination pharmacotherapy in a patient with schizophrenia
Inadequate response to initial antipsychotic therapy is relatively common in patients with schizophrenia. In case of inadequate response to initial antipsychotic treatment, it is possible to increase the dose of initial antipsychotic, replace the antipsychotic with another, or resort to a combination of antipsychotics. Insufficient response to antipsychotic treatment after two weeks is a negative predictor of response to the aforementioned treatment even in the longer term. Therefore, the period of two weeks from the start of treatment appears to be a suitable interval for assessing the effectiveness of an antipsychotic and also the time for intervention. Although clozapine is considered the gold standard in the treatment of drug-resistant schizophrenia, there are situations in clinical practice when further increasing clozapine may bring risk and combination therapy may bring benefit to the patient. With its receptor profile and minimal potential to increase weight gain and lead to deterioration of metabolic parameters, lurasidone appears to be a suitable candidate for the combination with clozapine. Knowledge of the effects of different doses of lurasidone on different symptom domains is important for making the right decision on the initial dose. Even after the initiation of combination antipsychotic treatment, it is appropriate to assess its effectiveness within two weeks of its initiation. Early increase in the dose of lurasidone in the absence of an early response led to an improvement in symptoms in patients compared with a more cautious strategy of keeping the original dose for a longer period. The presented case study illustrates the combined treatment with clozapine and lurasidone in a patient with paranoid schizophrenia using an early escalation strategy of lurasidone dose in the absence of adequate therapeutic response to initial dose after two weeks.
Keywords: polypharmacotherapy, pharmacoresistance, schizophrenia, early response to treatment
