Clozapine-resistant schizophrenia management: Combination and augmentation strategies and interactions

Chanoch Miodownik, Vladimir Lerner

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

The development of antipsychotics more than 60 years ago provided a crucial breakthrough in the treatment of schizophrenia. However, not all patients are positively affected by this treatment: from one fifth to one third are considered treatment resistant. These subjects have persistent psychotic symptoms and poor functioning despite adequate treatment with conventional or novel antipsychotics. To date, one of the most effective medications is clozapine, which produces clinically significant improvement of symptoms in 30-50% of patients receiving it. However, 40% to 70% of schizophrenia patients still have persistent ‘positive’ symptoms despite adequate dosage and duration of clozapine monotherapy. Among clozapine treatment resistant schizophrenia patients, 30% to 50% are treated with a combination of clozapine and a second psychotropic medication. Clinicians usually prescribe a combination of antipsychotics that actives a greater or more rapid therapeutic response than has been achieved with antipsychotic monotherapy. In this chapter, we present a summary of modern literature concerning the combination and augmentation of clozapine with different agents in the management of clozapine-resistant schizophrenia and schizoaffective patients.

Original languageEnglish
Title of host publicationClozapine
Subtitle of host publicationMedical Uses, Interactions and Side Effects
PublisherNova Science Publishers, Inc.
Pages87-169
Number of pages83
ISBN (Electronic)9781536169928
StatePublished - 1 Jan 2020

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