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No. 2 (2026)

GENERAL THERAPY QUESTIONS AND REVIEWS

Antipsychotic Polypharmacy Treatment

https://doi.org/10.48612/psyph/zm82-1zpn-ft34

Published 2026-06-30

  • N.N. Petrova

N.N. Petrova
Saint Petersburg State University

Abstract

Relevance. Antipsychotic combination therapy is a common treatment for psychoses, particularly schizophrenia, despite a lack of high-quality scientific evidence to rationally select treatment options. The aim of this narrative review was to integrate current scientific data on the prevalence, principles, and options of antipsychotic combination therapy, its efficacy and safety, and the pharmacological mechanisms of drug interactions.

Methods. A search for relevant publications was conducted in the electronic databases PubMed, Scopus, and eLIBRARY.RU. A combination of keywords was used to generate search queries: antipsychotics, antipsychotic polypharmacy, combined treatment, combined therapy, psychotic disorders, and their Russian-language equivalents. Inclusion criteria were randomized clinical trials, meta-analyses, systematic reviews, and relevant full-text articles on antipsychotic combination therapy. Exclusion criteria were low-quality articles (errors in methodology, unreliable data, bias or weak argumentation) and non-peer-reviewed publications. The terminology used in this article corresponds to that used in the included publications.

Results. This review describes the concept and presents data on the prevalence of various antipsychotic combination therapy options. The frequency of antipsychotic polytherapy in the treatment of psychosis ranges from 20 to 40 % and can be used to increase the effectiveness of relapse prevention and rehospitalization compared to antipsychotic monotherapy. Some combination therapy options can reduce the adverse effects of psychopharmacotherapy, such as weight gain, metabolic disorders, and increased prolactin levels. Given the pharmacological profile of the drugs, the combination of cariprazine and clozapine is expected to be effective, especially in patients with predominantly negative symptoms. The pharmacological mechanisms of antipsychotic interactions are discussed.

Conclusion. Antipsychotic polytherapy, regardless of class, is widely used in real-world clinical practice for many reasons and offers certain advantages in reducing the frequency of hospitalizations and the severity of psychopathological symptoms. Any antipsychotic regimen should include drugs that complement each other, have a favorable effect on efficacy, meet valid therapeutic goals, and avoid pharmacokinetic and pharmacodynamic risks.

Keywords

antipsychotics, combination therapy, treatment of psychosis, cariprazine

PDF (Русский)

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