Estrategias farmacológicas de potenciación en esquizofrenia refractaria a clozapina: más alla de la resistencia

Clozapine is currently the gold-standard in the treatment - resistant schizophrenia. After analyzing the use of clozapine under routine clinical conditions (dose, common adverse effects, outcome in resistant patients, issues related with agranulocytosis and seizures, indications for monitoring plasma levels), we present the augmentation strategies in the 40-70% of the patients who are resistant to clozapine. Augmentation strategies have been mostly derived from case-reports and open, non-controlled studies, rather than on controlled clinical-trials. Atypical antipsychotics have been used as augmentation strategies, such as, amisulpride and risperidone, with reasonable empirical support, and aripiprazole, with little empirical support. Mood regulators, such as lithium, valproic acid, and lamotrigine (the latter with sufficient empirical support) have been also used. Finally, several experimental treatments like NMDA-Glutamate modulators could be also effective a future augmentation strategy in the treatment of clozapine-resistant schizophrenia.