Lamotrigine–Clozapine Combination in Refractory Schizophrenia: Three Cases

Case Reports

Patient 1. Male, 36 years old. CLZ dosage 700 mg/day. Significant decrease of BPRS score was observed from 56 (day 0) to 49 (day 28, LMG 50 mg/day) to 43 (day 56, LMG 100 mg/day) to 30 (day 84, LMG 150 mg/day). Symptom improvement and increased autonomy have allowed his discharge for the first time after several years of hospitalization. Steady-state concentrations of CLZ, norclozapine (NCLZ), and LMG in plasma were 235 ng/ml, 230 ng/ml, and 0.78 μg/ml, respectively, at day 83 (LMG 125mg/day).

Patient 2. Male, 34 years old. CLZ dosage 500 mg/day. BPRS scores decreased from 66 (baseline) to 52 (day 28, LMG 50 mg/day), 52 (day 56, LMG 75 mg/day), and 52 (day 84, LMG 75 mg/day). Steady-state concentrations of CLZ, NCLZ, and LMG in plasma were 320 ng/ml, 405 ng/ml, and 0.57 μg/ml, respectively, at day 56 (LMG 75mg/day).

Patient 3. Female, 31 years old. CLZ dosage 700mg/day. BPRS scores decreased from 43 (baseline) to 35 (day 28, LMG 75 mg/day), 32 (day 56, LMG 75 mg/day), and 31 (day 84, LMG 200 mg/day). Steady-state concentration of CLZ, NCLZ, and LMG in plasma were 590 ng/ml, 420 ng/ml, and 1.28 μg/ml, respectively, at day 85 (LMG 200 mg/day).

No marked side effects, rash, or hematological changes were observed for any of these patients.

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