Chong S A, Remington G
Woodbridge Hospital and Institute of Mental Health, Singapore.
Schizophr Bull. 2000;26(2):421-40. doi: 10.1093/oxfordjournals.schbul.a033463.
While clozapine has been demonstrated to be efficacious in refractory schizophrenia and possibly schizoaffective as well as bipolar disorders, a substantial number of patients still remain unresponsive. One strategy in treating these refractory patients is to augment clozapine with other somatic treatments. This article reviews the efficacy and safety of the combination of clozapine with other somatic treatments. A total of 70 articles were obtained from a manual, as well as computerized (Medline), search of the English language literature from 1978 to March 1998. Few controlled studies exist; most were case reports/series. From these data, the greatest risk of adverse effects seems to be associated with clozapine combined with benzodiazepines, valproate, or lithium, but no currently evaluated combination is absolutely unsafe. In terms of efficacy, the data suggest a number of potential augmentation strategies, although controlled data are few. Combination therapies with clozapine are common in clinical practice, despite a lack of empirical data, and the benefits and risks of these combinations need to be systematically reviewed.
虽然氯氮平已被证明对难治性精神分裂症有效，可能对分裂情感性障碍以及双相情感障碍也有效，但仍有相当数量的患者对此无反应。治疗这些难治性患者的一种策略是用其他躯体治疗方法增强氯氮平的疗效。本文综述了氯氮平与其他躯体治疗联合使用的疗效和安全性。通过手工检索以及计算机检索（Medline）1978年至1998年3月的英文文献，共获得70篇文章。对照研究很少；大多数是病例报告/系列。从这些数据来看，不良反应的最大风险似乎与氯氮平联合苯二氮䓬类药物、丙戊酸盐或锂有关，但目前评估的联合用药没有一种是绝对安全的。在疗效方面，尽管对照数据很少，但数据表明有一些潜在的增效策略。尽管缺乏经验数据，但氯氮平联合治疗在临床实践中很常见，需要系统地评估这些联合治疗的益处和风险。
