Prescribing combinations of antipsychotics—antipsychotic polypharmacy (APP)— has a negative connotation because of limited efficacy and safety data, and limited endorsement in schizophrenia treatment guidelines. Caution with APP is warranted; a complex medication regimen may increase the potential for adverse effects, poorer adherence, and adverse drug-drug interactions. APP has been shown to independently predict both shorter treatment duration and discontinuation before 1 year.
Nonetheless, the clinician and patient may share the decision to implement APP and observe whether benefits outweigh risks in situations such as:
• to optimize neuroreceptor occupancy and targets (eg, attempting to achieve adequate D2 receptor blockade while minimizing side effects secondary to binding other receptors)
• to manage co-existing symptom domains (eg, mood changes, aggression, negative symptoms, disorganization, and cognitive deficits)
• to mitigate antipsychotic-induced side effects (eg, initiating aripiprazole to treat hyperprolactinemia induced by another antipsychotic to which the patient has achieved a favorable response).
See the entire article at…