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Nervenheilkunde 2007; 26(11): 1029-1035
DOI: 10.1055/s-0038-1626958
Original- und Übersichtsarbeiten - Original and Review Articles
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Kombinierte antipsychotische Therapie mit Clozapin und Aripiprazol

Combined antipsychotic treatment involving clozapin and aripiprazol
M. Zink
1   Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Universität Heidelberg, Mannheim (Ärztlicher Direktor: Prof. Dr. A. Meyer-Lindenberg)
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Publication History

Publication Date:
19 January 2018 (online)

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Zusammenfassung

Hintergrund: Therapieresistenz schizophrener Psychosen stellt ein häufiges Problem der antipsychotischen Pharmakotherapie dar. Patienten mit Teilremission unter Clozapintherapie werden oftmals kombiniert mit Aripiprazol behandelt. Da diese Strategie bislang nur kasuistisch berichtet wurde, wurde hier eine systematische Evaluation der vorliegenden Ergebnisse angestrebt.

Methode: Schlagwortbasierte Datenbankrecherche und systematische Auswertung der bis Oktober 2006 vorliegenden Publikationen.

Ergebnisse: In zehn Publikationen wurden die Verläufe von 92 Patienten erfasst. Eine klinische Besserung der therapieresistenten Symptomatik wurde unter durchschnittlich 20,1 mg Aripiprazol als Add-on zu Clozapin erreicht. Dabei konnte die Clozapindosis von 491 auf 435 mg/die abgesenkt werden, der Clozapinserumspiegel sank von 611 auf 523 ng/ml. Eine Linderung verschiedener, unerwünschter Clozapineffekte wurde erreicht, in Einzelfällen traten aber extrapyramidale Nebenwirkungen auf.

Schlussfolgerungen: Clozapin-resistente psychotische Symptome können sich unter Kombination mit Aripiprazol bessern, wobei die Ergebnisse placebokontrollierter Studien abgewartet werden müssen.

Summary

Objective: Treatment resistant schizophrenia is a challenging problem of antipsychotic pharmacotherapy. In these cases, combined treatment approaches are frequently used, such as the add-on of aripiprazole to clozapine. This review summarizes publications about this strategy.

Methods: Keyword-based screening of databases and systematic evaluation of the data.

Results: The courses of 92 patients were reported in 10 publications. Aripiprazole was applied with on average 20.1 mg/day, facilitated clinical improvement of psychotic symptoms, as well asa reduction of clozapine dose from 491 to 435 mg/die. In parallel, the serum level decreased from 611 to 523 ng/ml. Clozapine-induced side effects ameliorated, such as hyper salivation, gain of body weight, diabetes mellitus, alterations of serum lipids and obsessive-compulsive symptoms. No pharmacokinetic interactions were reported, however cases of extrapyramidal side effects.

Conclusions: The combination of clozapine and aripiprazole followsa neurobiological rationale and appears to be effective and tolerable. The results of placebo-controlled trials might allow further insight into benefits and risks of this strategy.

Schlüsselworte

Aripiprazol - Augmentation - Clozapin - Kombination - Schizophrenie

Keywords

Aripiprazole - augmentation - clozapine - combination - schizophrenia
 

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