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DTB: Vol 20, No 5: October - December 2012

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Antipsychotic therapy after failure with first-line treatment: should we increase the dose, switch drugs, or combine antipsychotics?

Before opting for pharmacological management for patients with schizophrenia, psychotherapy and the prescription of physical exercise should be considered. If there is no improvement then medication could be indicated. When the initial medication fails, the first step would be to increase the medication up to the maximum dose; if not effective, the drug could be replaced by another antipsychotic agent, and if this fails, then clozapine should be considered. In cases of adherence problems, it may be useful to employ intramuscular administration of long-acting antipsychotic drugs. The combination of two or more antipsychotic drugs is not recommended in any case.


  • LUCIA MORENO. Psychiatrist. Navarre Hospital Complex. Navarre Health Service. Spain
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