Amisulpride Augmentation of Clozapine in Refractory Schizophrenia

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Back to table of contents Previous article Next article LettersFull AccessAmisulpride Augmentation of Clozapine in Refractory SchizophreniaHsiu-Wen Chiu, M.D., Yu-Chi Ku, M.D., Tien-Chun Li, M.D., and Hsin-Te Huang, M.D.Hsiu-Wen ChiuSearch for more papers by this author, M.D., Yu-Chi KuSearch for more papers by this author, M.D., Tien-Chun LiSearch for more papers by this author, M.D., and Hsin-Te HuangSearch for more papers by this author, M.D.Published Online:1 Jul 2011AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Clozapine, an atypical antipsychotic drug, is the first-choice medication for treatment-refractory schizophrenia. However, clozapine can cause some adverse effects, such as agranulocytosis and sialorrhea, making it difficult for patients to continue with treatment. Otherwise, treatment options for patients who are resistant to clozapine are extremely limited. Herein, the authors report the case of a patient with refractory schizophrenia treated by amisulpride augmentation of clozapine who got significant improvement not only in his positive and negative symptoms but also the side effect of salivation. This case report might provide an alternative treatment for refractory schizophrenia.Case ReportA 53-year-old man with chronic, refractory schizophrenia was hospitalized because of his symptoms of hostility, aggression, insomnia, delusions, and auditory hallucinations, despite his medication with clozapine 200 mg per day. His initial laboratory studies revealed no remarkable findings. Clozapine was titrated to 350 mg per day for marked psychotic symptoms, but it seemed to be only slightly effective. Meanwhile, he complained of salivation worsening and wanted to discontinue clozapine treatment because of this adverse effect. We then added amisulpride 600 mg per day for augmentation of clozapine. Interestingly, there was a significant improvement in his auditory hallucinations, delusions, conceptual disorganization, and on the positive and negative syndrome scale (PANSS). Also, the adverse effect of sialorrhea was improved during the following days and nights.DiscussionClozapine is used to treat severe schizophrenia symptoms in people who have not responded to or only partially responded to other antipsychotics. Sialorrhea is a common side effect leading to treatment noncompliance, occurring in about 31%–54% of patients receiving clozapine therapy.1 Amisulpride, an atypical antipsychotic, possesses a higher selective binding to the D2/D3 dopamine receptor and a minimal effect on other receptors.2 Clozapine produces moderate blocking of the D2 dopamine receptors, whereas amisulpride is a potent antagonist of D2 dopamine receptors. The efficacy of the combination may be due to the complementary receptor profile of the two drugs. In this report, amisulpride might be augmentative therapy for clozapine in patients who are not responsive to or only partially responsive to clozapine. Kreinin et al.3 reported a significant reduction in hypersalivation with addition of amisulpride to ongoing clozapine therapy. In our case, both daytime as well as nocturnal sialorrhea improved after the addition of amisulpride. However, the definite underlying mechanism is still unknown. In summary, our case suggested that amisulpride improve the antipsychotic effect of clozapine while improving the major adverse event of sialorrhea. Amisulpride augmentation of clozapine might be an optional approach to treatment-refractory schizophrenia.Department of Psychiatry, Beitou Armed Forces Hospital, 60, Xinmin Rd., Beitou Dist., Taipei 112, Taiwan.e-mail address: [email protected]com (Ms. Chiu), [email protected]com (Dr. Huang)1. Davydov L , Botts SR : Clozapine-induced hypersalivation. Ann Pharmacother 2000; 34:662–665Crossref, Medline, Google Scholar2. Natesan S , Reckless GE , Barlow KB , et al.: Amisulpride: the “atypical” atypical antipsychotic: comparison to haloperidol, risperidone, and clozapine. Schizophr Res 2008; 105(1–3):224–235Crossref, Medline, Google Scholar3. Kreinin A , Novitski D , Weizman A : Amisulpride treatment of clozapine-induced hypersalivation in schizophrenia patients: a randomized, double-blind, placebo-controlled cross-over study. Int Clin Psychopharmacol 2006; 21:99–103Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 23Issue 3 Summer 2011Pages E15-E15 Metrics PDF download History Published online 1 July 2011 Published in print 1 July 2011