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Pharmacopsychiatry 2014; 47(07): 263-267
DOI: 10.1055/s-0034-1390469
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Antipsychotic Agents used to Augment Clozapine during Long-Term Inpatient Hospitalizations

J. G. Leung
1   Department of Hospital Pharmacy Services, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
,
K. N. R. Chengappa
2   Western Psychiatric Institute and Clinic of UPMC, Department of Psychiatry, University of Pittsburgh School of Medicine, PA USA
,
E. Ivanov
2   Western Psychiatric Institute and Clinic of UPMC, Department of Psychiatry, University of Pittsburgh School of Medicine, PA USA
,
G. Gandotra
2   Western Psychiatric Institute and Clinic of UPMC, Department of Psychiatry, University of Pittsburgh School of Medicine, PA USA
,
C. E. Kahn
2   Western Psychiatric Institute and Clinic of UPMC, Department of Psychiatry, University of Pittsburgh School of Medicine, PA USA
,
J. S. Weber
3   Western Psychiatric Institute and Clinic of UPMC, University of Pittsburgh School of Pharmacy, Pittsburgh, PA USA
,
T. J. Fabian
3   Western Psychiatric Institute and Clinic of UPMC, University of Pittsburgh School of Pharmacy, Pittsburgh, PA USA
› Author Affiliations
Further Information

Publication History

received 06 August 2014
revised 29 August 2014

accepted 08 September 2014

Publication Date:
08 October 2014 (online)

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Abstract

Introduction: Literature assessing effective clozapine augmentation strategies is limited. The aim of this retrospective evaluation was to examine antipsychotics used to augment clozapine and assess whether an augmentation antipsychotic would continue at discharge.

Methods: Demographic, clinical and pharmacy data were collected retrospectively if patients had received clozapine plus an antipsychotic used for augmentation. The dose of the augmentation agent, length of augmentation therapy, and concomitant medications were collected.

Results: Of the 49 patients (mean age 45.3±12.1 years), 27 (55%) were male. The mean clozapine dose at discharge was 406.1±121.8 mg. When a first generation antipsychotic (FGA) was selected initially to augment clozapine there was a greater likelihood it would be continued until discharge compared to a second generation antipsychotic (SGA) (78 vs. 50%, OR=3.6, 95% CI 1.03–12.6). FGAs (3.2%) compared to SGAs (35%) were less likely to be discontinued due to a documented lack of benefit when first selected to augment clozapine (OR=16.2, 95% CI 2–131.3). Electroconvulsive therapy plus clozapine was found to be beneficial in several patients (n=14) who failed at least 1 augmentation strategy.

Discussion: This real world data suggests that adding an antipsychotic to clozapine is a reasonable approach to those who do not fully respond to clozapine monotherapy. While comparisons of all agents could not be conducted from this small retrospective study, these data suggest FGAs should be investigated in future studies as potential agents to successfully augment clozapine therapy.

Key words

clozapine - augmentation - treatment-resistant schizophrenia - antipsychotics - electroconvulsive therapy
 

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