Risperidone augmentation of clozapine. 1995

R H McCarthy, and K G Terkelsen
Cornell University Medical College, New York Hospital-Westchester Division, New York, USA.

While effective as a single agent in a significant proportion of treatment refractory patients, clozapine is often used in combination with other medications, including classical neuroleptics (1), mood stabilizers and antidepressants (2), benzodiazepines (3) and lithium (4). In Denmark, where clozapine has been in near continuous use since 1975, up to 60% of clozapine patients receive additional medication (4). Classical neuroleptics, often at antipsychotic levels, are the medications most frequently added, and are used in 30-35% of patients receiving clozapine (4,5). Clozapine, due to its low D2-blocking effect, may be therapeutically insufficient to contain symptoms and additional agents may be required (4). In controlled clinical trials risperidone has been shown to be superior to haloperidol (6), but has not yet been rigorously compared to clozapine. In light of its established efficacy and pharmacological profile (7) risperidone may be reasonably construed to be a medication with efficacy somewhere between clozapine and classical neuroleptics. As such, it may be especially well suited for use with clozapine as a part of an augmentation strategy. There are no reports in the literature describing the concurrent use of risperidone and clozapine. We present two cases demonstrating augmentation of clozapine's effects through combined use with clozapine.

UI MeSH Term Description Entries
D007555 Isoxazoles Azoles with an OXYGEN and a NITROGEN next to each other at the 1,2 positions, in contrast to OXAZOLES that have nitrogens at the 1,3 positions. Isoxazole
D008297 Male Males
D010880 Piperidines A family of hexahydropyridines.
D011618 Psychotic Disorders Disorders in which there is a loss of ego boundaries or a gross impairment in reality testing with delusions or prominent hallucinations. (From DSM-IV, 1994) Psychoses,Psychosis, Brief Reactive,Schizoaffective Disorder,Schizophreniform Disorders,Psychosis,Brief Reactive Psychoses,Brief Reactive Psychosis,Disorder, Psychotic,Disorder, Schizoaffective,Disorder, Schizophreniform,Disorders, Psychotic,Disorders, Schizoaffective,Disorders, Schizophreniform,Psychoses, Brief Reactive,Psychotic Disorder,Reactive Psychoses, Brief,Reactive Psychosis, Brief,Schizoaffective Disorders,Schizophreniform Disorder
D003024 Clozapine A tricylic dibenzodiazepine, classified as an atypical antipsychotic agent. It binds several types of central nervous system receptors, and displays a unique pharmacological profile. Clozapine is a serotonin antagonist, with strong binding to 5-HT 2A/2C receptor subtype. It also displays strong affinity to several dopaminergic receptors, but shows only weak antagonism at the dopamine D2 receptor, a receptor commonly thought to modulate neuroleptic activity. Agranulocytosis is a major adverse effect associated with administration of this agent. Clozaril,Leponex
D004359 Drug Therapy, Combination Therapy with two or more separate preparations given for a combined effect. Combination Chemotherapy,Polychemotherapy,Chemotherapy, Combination,Combination Drug Therapy,Drug Polytherapy,Therapy, Combination Drug,Chemotherapies, Combination,Combination Chemotherapies,Combination Drug Therapies,Drug Polytherapies,Drug Therapies, Combination,Polychemotherapies,Polytherapies, Drug,Polytherapy, Drug,Therapies, Combination Drug
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D012563 Schizophrenia, Paranoid A chronic form of schizophrenia characterized primarily by the presence of persecutory or grandiose delusions, often associated with hallucination. Delusional Disorder,Paranoid Schizophrenia,Delusional Disorders,Disorder, Delusional,Disorders, Delusional,Paranoid Schizophrenias,Schizophrenias, Paranoid
D012565 Schizophrenic Psychology Study of mental processes and behavior of schizophrenics. Psychology, Schizophrenic

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