Abstract:
:Antipsychotic polypharmacy refers to the co-prescription of more than one antipsychotic drug for an individual patient. Surveys of prescribing in psychiatric services internationally have identified the relatively frequent and consistent use of combined antipsychotics, usually for people with established schizophrenia, with a prevalence of up to 50% in some clinical settings. A common reason for prescribing more than one antipsychotic is to gain a greater or more rapid therapeutic response than has been achieved with antipsychotic monotherapy. However, the evidence on the risks and benefits for such a strategy is equivocal, and not generally considered adequate to warrant a recommendation for its use in routine clinical practice in psychiatry. Combined antipsychotics are a major contributor to high-dose prescribing, associated with an increased adverse effect burden, and of limited value in helping to establish the optimum maintenance regimen for a patient. The relatively widespread use of antipsychotic polypharmacy identified in cross-sectional surveys reflects not only the addition of a second antipsychotic to boost therapeutic response, but also the use of as-required antipsychotic medication (mainly to treat disturbed behaviour), gradual cross-titration while switching from one antipsychotic to another, and augmentation of clozapine with a second antipsychotic where the illness has failed to respond adequately to an optimized trial of clozapine. This review addresses the clinical trial data and other evidence for each of these pharmacological approaches. Also reviewed are examples of systematic, practice-based interventions designed to reduce the prevalence of antipsychotic polypharmacy, most of which have met with only modest success. Guidelines generally agree that if combined antipsychotics are prescribed to treat refractory psychotic illness, this should be after other, evidence-based, pharmacological treatments such as clozapine have been exhausted. Further, their prescription for each patient should be in the context of an individual trial, with monitoring of the clinical response and adverse effects, and appropriate physical health monitoring.
journal_name
CNS Drugsjournal_title
CNS drugsauthors
Barnes TR,Paton Cdoi
10.2165/11587810-000000000-00000subject
Has Abstractpub_date
2011-05-01 00:00:00pages
383-99issue
5eissn
1172-7047issn
1179-1934pii
3journal_volume
25pub_type
杂志文章,评审相关文献
CNS DRUGS文献大全abstract:BACKGROUND:Responses to atomoxetine vary for individual patients with attention-deficit/hyperactivity disorder (ADHD). However, we do not know whether any factors can be used to reliably predict how individuals with ADHD will respond to treatment. OBJECTIVE:Our objective was to evaluate background variables that facil...
journal_title:CNS drugs
pub_type: 临床试验,杂志文章
doi:10.1007/s40263-016-0323-x
更新日期:2016-04-01 00:00:00
abstract::Progress in finding a better alternative to alteplase has been slow. Tenecteplase and desmoteplase have better pharmacological profiles compared with alteplase, but definite clinical evidence of their superiority is lacking. The two major phase III studies that have tested the efficacy and safety of desmoteplase in is...
journal_title:CNS drugs
pub_type: 杂志文章
doi:10.1007/s40263-015-0307-2
更新日期:2016-02-01 00:00:00
abstract::This article reviews the conceptual progression in the pharmacological therapy of malignant astrocytoma (MA) over the past decade, and its future trends. It is a selective rather than an exhaustive inventory of literature citations. The experience of the Brain Tumour Cooperative Group (BTCG) and earlier phase III tria...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/00023210-200115090-00005
更新日期:2001-01-01 00:00:00
abstract::In this article, we review the evidence that tocopherol (vitamin E) may have a role to play in the prevention and treatment of Alzheimer's disease and other neurological diseases. The theoretical rationale for the effectiveness of tocopherol as treatment and/or prevention of Alzheimer's disease is based on its antioxi...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/00023210-200418120-00005
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:Valproate is a first-line antiepileptic agent and is also used in the treatment of bipolar disorder and migraine. It is a known human teratogen. The objective of the study was to evaluate the teratogenic risk of valproate. METHODS:All callers who contacted the Israeli Teratology Information Service (TIS) be...
journal_title:CNS drugs
pub_type: 杂志文章
doi:10.2165/00023210-200822040-00004
更新日期:2008-01-01 00:00:00
abstract::There is escalating interest in cell-based therapies to restore lost dopamine inputs in Parkinson's disease. This is based upon the rationale that implanting dopamine progenitors into the striatum can potentially improve dopamine-responsive motor symptoms. A rich body of data describing clinical trials of previous cel...
journal_title:CNS drugs
pub_type: 杂志文章
doi:10.1007/s40263-020-00727-3
更新日期:2020-06-01 00:00:00
abstract::Attention-deficit/hyperactivity disorder, or ADHD, is the most frequently occurring neurobiological disorder in childhood and is defined by symptoms of inattention and/or hyperactivity and impulsivity that are excessive when compared with other individuals at the same developmental level. ADHD can be successfully trea...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-013-0130-6
更新日期:2014-02-01 00:00:00
abstract::Sodium channel blockers have been the mainstay of the pharmacological management of focal and generalised tonic-clonic seizures for more than 70 years. The focus of this paper will be on phenytoin, carbamazepine, lamotrigine, oxcarbazepine, rufinamide, lacosamide and eslicarbazepine acetate. All these antiepileptic dr...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-017-0441-0
更新日期:2017-07-01 00:00:00
abstract::The basal ganglia and dopaminergic pathways play a central role in hyperkinetic movement disorders. Vesicular monoamine transporter 2 (VMAT2) inhibitors, which deplete dopamine at presynaptic striatal nerve terminals, are a class of drugs that have long been used to treat hyperkinetic movement disorders, but have rece...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-018-0580-y
更新日期:2018-12-01 00:00:00
abstract::Diclofenac potassium powder for oral solution (Voltfast(®), Catafast(®), Cambia(®); hereafter referred to as diclofenac potassium powder) is a non-steroidal anti-inflammatory drug (NSAID), and is indicated for the acute treatment of migraine. This article reviews the pharmacological properties of diclofenac potassium ...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-014-0186-y
更新日期:2014-08-01 00:00:00
abstract::In recent years, several new antiepileptic drugs (AEDs) have been licensed: felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, vigabatrin and zonisamide. These drugs have proven efficacy as add-on therapy in patients with difficult-to-treat partial epilepsy, as 20-50% of patients ...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/00023210-200317060-00003
更新日期:2003-01-01 00:00:00
abstract::Risperidone (Risperdal), a psychotropic atypical antipsychotic agent, is thought to act via dopamine D(2) and serotonin 5-HT(2A) receptor antagonism. The clinical efficacy of oral risperidone in the treatment of bipolar mania and schizophrenia in adult patients is well established. In the US, risperidone is also appro...
journal_title:CNS drugs
pub_type: 评论,杂志文章
doi:10.2165/00023210-200822030-00006
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Several small studies have shown beneficial effects of ondansetron, a serotonin 5-HT(3) receptor antagonist, in the treatment of obsessive-compulsive disorder (OCD). The efficacy of other 5-HT(3) receptor antagonists in patients with OCD is still unclear. Granisetron does not alter cytochrome P450 activity a...
journal_title:CNS drugs
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.2165/11635850-000000000-00000
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Patients with focal seizures recruited into adjunctive antiepileptic drug (AED) trials have become more refractory and severe over time; concurrently, placebo responses have increased. To attempt to account for heterogeneity among trials, propensity-score weighted patient-level data were used t...
journal_title:CNS drugs
pub_type: 杂志文章,随机对照试验
doi:10.1007/s40263-017-0462-8
更新日期:2017-10-01 00:00:00
abstract::Major depressive disorder (MDD) is a chronic, recurrent mental disease that causes serious disability. Because currently available antidepressants have limited efficacy with respect to response and remission in patients with MDD, clinicians must choose the best available treatment interventions for patients who do not...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-012-0032-z
更新日期:2013-05-01 00:00:00
abstract:OBJECTIVES:Atomoxetine is commonly used to treat attention-deficit hyperactivity disorder (ADHD) in children with a broad range of cognitive abilities. We examined the association between level of cognitive functioning as determined by IQ and clinical response during treatment with atomoxetine. METHODS:The records of ...
journal_title:CNS drugs
pub_type: 杂志文章
doi:10.2165/11590450-000000000-00000
更新日期:2011-06-01 00:00:00
abstract::An explosion in antiepileptic drug (AED) therapy began in the 1990s with the licensing of 9 new chemical entities and more to come. Important differences between AEDs may not be detected by regulatory trials, which are designed to satisfy licensing requirements and often diverge considerably from everyday clinical pra...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/00023210-200115010-00001
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Cenobamate is a novel tetrazole-derived carbamate compound with a dual mechanism of action. This drug can enhance the inactivated state of voltage-gated sodium channels, preferentially inhibiting the persistent component of the sodium channel current, and acts as a positive allosteric modulator of GABAA rece...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-020-00759-9
更新日期:2020-11-01 00:00:00
abstract::Once considered rare and resistant to treatment, obsessive-compulsive disorder (OCD) has now emerged as a common, yet often unrecognized, psychiatric condition. Treatment with selective serotonin reuptake inhibitors (SSRIs) is effective in 40-60% of patients with OCD. Management of the remaining 40-60% of patients wit...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/11587860-000000000-00000
更新日期:2011-07-01 00:00:00
abstract::Treatment-resistant depression (TRD) presents major challenges for both patients and clinicians. There is no universally accepted definition of TRD, but results from the US National Institute of Mental Health's (NIMH) STAR*D (Sequenced Treatment Alternatives to Relieve Depression) programme indicate that after the fai...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/11530280-000000000-00000
更新日期:2010-02-01 00:00:00
abstract::Anticonvulsant hypersensitivity syndrome (AHS) is a rare, but potentially fatal, adverse reaction that occurs in patients, including children, who are treated with anticonvulsants. During metabolism of the anticonvulsant, toxic arene-oxide compounds are produced. AHS is associated with both cutaneous and systemic symp...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/00023210-200216030-00006
更新日期:2002-01-01 00:00:00
abstract::Social anxiety disorder (SAD) is a prevalent and disabling disorder associated with significant co-morbidity. An increased awareness of SAD over the past two decades has given impetus to advances in the pharmacotherapeutic and psychotherapeutic treatment options for this disorder. On the basis of consistent data from ...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/00023210-200519050-00002
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:Refractory status epilepticus (RSE) is an emergency with high mortality requiring neurointensive care. Treatment paradigms include first-generation antiepileptic drugs (AEDs) and anesthetics. Lacosamide (LCM) is a new AED, holding promise as a potent treatment option for RSE. High-level evidence regarding sa...
journal_title:CNS drugs
pub_type: 杂志文章
doi:10.1007/s40263-013-0049-y
更新日期:2013-04-01 00:00:00
abstract::The coronavirus 2019 (COVID-19) pandemic is expected to linger. Decisions regarding initiation or continuation of disease-modifying therapy for multiple sclerosis have to consider the potential relevance to the pandemic. Understanding the mechanism of action and the possible idiosyncratic effects of each therapeutic a...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-020-00756-y
更新日期:2020-09-01 00:00:00
abstract::Despite the established efficacy of chimeric antigen receptor (CAR) T-cell therapy in hematologic malignancies, translating CAR T therapy to solid tumors has remained investigational. Glioblastoma, the most aggressive and lethal form of primary brain tumor, has recently been among the malignancies being trialed clinic...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-019-00687-3
更新日期:2020-02-01 00:00:00
abstract::Oral fingolimod (Gilenya™), a sphingosine 1-phosphate (S1P) receptor agonist, is the first oral agent and the first in a novel class of disease-modifying therapies (DMTs) to be approved for use in the US for the treatment of relapsing forms of multiple sclerosis (MS). In the EU, fingolimod is approved for use as a sin...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.2165/11207350-000000000-00000
更新日期:2011-08-01 00:00:00
abstract::Aripiprazole (Abilify(®)) is an atypical antipsychotic that is widely used in the treatment of psychiatric conditions. Unlike other currently available atypical antipsychotics that primarily have varying degrees of dopamine D2 receptor antagonism, aripiprazole is a partial agonist at D2 and serotonin 5-HT1A receptors,...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-013-0134-2
更新日期:2014-02-01 00:00:00
abstract::Ursolic acid is a pentacyclic triterpenoid found in several plants. Despite its initial use as a pharmacologically inactive emulsifier in pharmaceutical, cosmetic and food industries, several biological activities have been reported for this compound so far, including anti-tumoural, anti-diabetic, cardioprotective and...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-017-0474-4
更新日期:2017-12-01 00:00:00
abstract::Methylene blue is a long-established drug with complex pharmacology and multiple clinical indications. Its diverse mechanisms of action are most likely responsible for the large variety of its clinical effects. Of interest to psychiatrists, methylene blue has antidepressant, anxiolytic, and neuroprotective properties ...
journal_title:CNS drugs
pub_type: 杂志文章,评审
doi:10.1007/s40263-019-00641-3
更新日期:2019-08-01 00:00:00
abstract::The original article can be found online. ...
journal_title:CNS drugs
pub_type: 杂志文章,已发布勘误
doi:10.1007/s40263-018-0561-1
更新日期:2018-09-01 00:00:00