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Augmentation of Clozapine with Aripiprazole in Severe Psychotic Bipolar and Schizoaffective Disorders: A Pilot Study

AIM: To evaluate the efficacy and safety of the augmentation of clozapine with aripiprazole in patients with treatment-resistant schizoaffective and psychotic bipolar disorders in a retrospective manner. Pharmacodynamic and pharmacokinetic interactions between the two drugs were also investigated. P...

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Autores principales: Benedetti, Alessandra, Di Paolo, Antonello, Lastella, Marianna, Casamassima, Francesco, Candiracci, Chiara, Litta, Antonella, Ciofi, Laura, Danesi, Romano, Lattanzi, Lorenzo, Del Tacca, Mario, Cassano, Giovanni Battista
Formato: Texto
Lenguaje:English
Publicado: Bentham Open 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905769/
https://www.ncbi.nlm.nih.gov/pubmed/20648219
http://dx.doi.org/10.2174/1745017901006010030
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author Benedetti, Alessandra
Di Paolo, Antonello
Lastella, Marianna
Casamassima, Francesco
Candiracci, Chiara
Litta, Antonella
Ciofi, Laura
Danesi, Romano
Lattanzi, Lorenzo
Del Tacca, Mario
Cassano, Giovanni Battista
author_facet Benedetti, Alessandra
Di Paolo, Antonello
Lastella, Marianna
Casamassima, Francesco
Candiracci, Chiara
Litta, Antonella
Ciofi, Laura
Danesi, Romano
Lattanzi, Lorenzo
Del Tacca, Mario
Cassano, Giovanni Battista
author_sort Benedetti, Alessandra
collection PubMed
description AIM: To evaluate the efficacy and safety of the augmentation of clozapine with aripiprazole in patients with treatment-resistant schizoaffective and psychotic bipolar disorders in a retrospective manner. Pharmacodynamic and pharmacokinetic interactions between the two drugs were also investigated. PATIENTS: Three men and 4 women (median age 36 and 40 years, respectively) who had mean scores at BPRS and CGI-Severity of 59.1±12.0 and 5.4±0.5, respectively, were treated with clozapine (mean dose 292.9±220.7 mg/day). Patients received an adjunctive treatment with aripiprazole (mean dose 6.8 ± 3.7 mg/day). Clozapine, norclozapine and aripiprazole plasma levels were measured by means of a high performance liquid chromatograpy with UV detection. RESULTS: Total scores at BPRS decreased significantly (from 59.1±12.0 to 51.1±15.6, p=0.007) after aripirazole augmentation. In particular, the factors “thought disorder” (from 10.4±4.4 to 9.0±4.5, p=.047) and “anergia” (from 10.0±2.7 to 8.0±2.4, p=.018) significantly improved. Concomitant administration of aripiprazole and clozapine did not result in an increase in side effects over the period of treatment. Dose-normalized plasma levels of both clozapine and norclozapine and the clozapine/norclozapine metabolic ratio in all patients did not vary as well. CONCLUSION: The augmentation of clozapine with aripirazole was safe and effective in severe psychotic schizoaffective and bipolar disorders which failed to respond to atypical antipsychotics. A possible pharmacokinetic interaction between clozapine and aripiprazole does not account for the improved clinical benefit obtained after aripiprazole augmentation.
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spelling pubmed-29057692010-07-20 Augmentation of Clozapine with Aripiprazole in Severe Psychotic Bipolar and Schizoaffective Disorders: A Pilot Study Benedetti, Alessandra Di Paolo, Antonello Lastella, Marianna Casamassima, Francesco Candiracci, Chiara Litta, Antonella Ciofi, Laura Danesi, Romano Lattanzi, Lorenzo Del Tacca, Mario Cassano, Giovanni Battista Clin Pract Epidemiol Ment Health Article AIM: To evaluate the efficacy and safety of the augmentation of clozapine with aripiprazole in patients with treatment-resistant schizoaffective and psychotic bipolar disorders in a retrospective manner. Pharmacodynamic and pharmacokinetic interactions between the two drugs were also investigated. PATIENTS: Three men and 4 women (median age 36 and 40 years, respectively) who had mean scores at BPRS and CGI-Severity of 59.1±12.0 and 5.4±0.5, respectively, were treated with clozapine (mean dose 292.9±220.7 mg/day). Patients received an adjunctive treatment with aripiprazole (mean dose 6.8 ± 3.7 mg/day). Clozapine, norclozapine and aripiprazole plasma levels were measured by means of a high performance liquid chromatograpy with UV detection. RESULTS: Total scores at BPRS decreased significantly (from 59.1±12.0 to 51.1±15.6, p=0.007) after aripirazole augmentation. In particular, the factors “thought disorder” (from 10.4±4.4 to 9.0±4.5, p=.047) and “anergia” (from 10.0±2.7 to 8.0±2.4, p=.018) significantly improved. Concomitant administration of aripiprazole and clozapine did not result in an increase in side effects over the period of treatment. Dose-normalized plasma levels of both clozapine and norclozapine and the clozapine/norclozapine metabolic ratio in all patients did not vary as well. CONCLUSION: The augmentation of clozapine with aripirazole was safe and effective in severe psychotic schizoaffective and bipolar disorders which failed to respond to atypical antipsychotics. A possible pharmacokinetic interaction between clozapine and aripiprazole does not account for the improved clinical benefit obtained after aripiprazole augmentation. Bentham Open 2010-06-04 /pmc/articles/PMC2905769/ /pubmed/20648219 http://dx.doi.org/10.2174/1745017901006010030 Text en © Benedetti et al.; Licensee Bentham Open. http://creativecommons.org/licenses/by-nc/3.0/ This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
spellingShingle Article
Benedetti, Alessandra
Di Paolo, Antonello
Lastella, Marianna
Casamassima, Francesco
Candiracci, Chiara
Litta, Antonella
Ciofi, Laura
Danesi, Romano
Lattanzi, Lorenzo
Del Tacca, Mario
Cassano, Giovanni Battista
Augmentation of Clozapine with Aripiprazole in Severe Psychotic Bipolar and Schizoaffective Disorders: A Pilot Study
title Augmentation of Clozapine with Aripiprazole in Severe Psychotic Bipolar and Schizoaffective Disorders: A Pilot Study
title_full Augmentation of Clozapine with Aripiprazole in Severe Psychotic Bipolar and Schizoaffective Disorders: A Pilot Study
title_fullStr Augmentation of Clozapine with Aripiprazole in Severe Psychotic Bipolar and Schizoaffective Disorders: A Pilot Study
title_full_unstemmed Augmentation of Clozapine with Aripiprazole in Severe Psychotic Bipolar and Schizoaffective Disorders: A Pilot Study
title_short Augmentation of Clozapine with Aripiprazole in Severe Psychotic Bipolar and Schizoaffective Disorders: A Pilot Study
title_sort augmentation of clozapine with aripiprazole in severe psychotic bipolar and schizoaffective disorders: a pilot study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905769/
https://www.ncbi.nlm.nih.gov/pubmed/20648219
http://dx.doi.org/10.2174/1745017901006010030
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