Effectiveness of amisulpride augmentation of clozapine in a non‐responder to either drug alone: a case report

We read with interest the paper by Munro et al. (1), discussing the efficacy of amisulpride augmentation of clozapine, in treating schizophrenic patients who respond poorly to clozapine. This study lends further support to accumulating evidence for the use of clozapine–amisulpride combination in the treatment of refractory schizophrenia (2–4). An as yet unanswered question, and an important limitation of this study (1), as the authors point out is that – it did not address the possibility that amisulpride might own its own dowhat clozapine has failed to do .We briefly discuss a case, which answers precisely this question. Mrs B is a 36-year-old, Caucasian lady, with a 10-year history of paranoid schizophrenia. Over the last 2 years she has had three admissions to an acute inpatient psychiatric ward and has spent a total of 18 months in hospital during this time. Her predominant symptoms over the last year have been multiple bizarre delusions, second person auditory hallucinations, lack of insight and poor self-care. She was treated with trifluperazine, risperidone, amisulpride and clopixol depot (all in therapeutic doses and for adequate lengths of time) at various phases during her illness with poor results. In view of the refractoriness of her illness, she was started on clozapine (up to 400 mg daily, with plasma levels within therapeutic range), to which she was poorly tolerant (severe drowsiness) and relapsed within a few months. As a result of the poor symptom control with clozapine alone, it was decided to try clozapine–amisulpride combination. She has been on 400 mg of clozapine and 400 mg of amisulpride for 6 weeks. Over the first 4 weeks, she showed a remarkable improvement in psychotic symptoms, with no significant side effects, and this has been sustained. She moved on from the acute ward to a rehabilitation nursing home and started to spend time productively with her family. Although no objective assessments were made, this clinical improvement indicates the effectiveness of the drug treatment. We conclude that this case supports the view that clozapine– amisulpride combination is useful in treating refractory schizophrenia even in those cases where amisulpride and clozapine have been ineffective on their own. Long-term follow up with larger samples is needed before firm conclusions can be drawn.