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Combinations of Two Antipsychotics | Combinations of Antidepressants and Antipsychotics | Combinations of Mood Stabilizers and Antipsychotics | Other Augmentation Strategies
Excerpt
Combining two or more antipsychotics is generally frowned
upon, since the utility of this approach is not clear. However,
an atypical antipsychotic can sometimes be augmented by a standard
antipsychotic drug. The most common example is the combination of
clozapine, which has limited D2 antagonism,
and haloperidol or perphenazine. Although few data are available
on the efficacy of this approach, some patients appear to benefit. Risperidone
combined with a standard antipsychotic resulted in a modest but
significant improvement in some patients with chronic schizophrenia studied
prospectively (Takahashi et al. 1999). The combination
of other atypical antipsychotics and standard antipsychotics may
also be warranted if the maximum dosage of the atypical agent has
been achieved with less than satisfactory benefit. We tend to prefer
the addition of high-potency agents, because the weight gain, hypotensive,
and sedation problems associated with the atypical antipsychotics
complicate the addition of low-potency agents. Since risperidone
is such a potent D2 antagonist by itself,
we push the dosage of risperidone as tolerated by the patient up
to 12 mg/day rather than add a standard antipsychotic to
it.