Raskin S, Durst R, Katz G, Zislin J
The Jerusalem Mental Health Center, Kfar Shaul Hospital, affiliated with the Hebrew University-Hadassah Medical School, Israel.
J Clin Psychopharmacol. 2000 Oct;20(5):500-3. doi: 10.1097/00004714-200010000-00002.
Coadministration of olanzapine, an atypical neuroleptic, with sulpiride, a selective D2 antagonist, is suggested as an efficient strategy for treating patients with resistant unremitting schizophrenia. The psychopharmacologic rationale that may account for the enhanced clinical efficacy of combining sulpiride with olanzapine and vice versa is the difference in affinity of the two drugs to brain receptors. Olanzapine affinity is related more to serotonin 5-HT2 than to dopamine-2, whereas sulpiride is considered a selective D2 blocker. The adjunction of a selective D2 antagonist to olanzapine may act as the olanzapine's augmentor by enhancing D2 blockage. This mode of treatment was introduced to six patients with chronic schizophrenia who showed noteworthy and rapid clinical improvement, supported by a decrease in their scores on the Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale. No bothersome side effects were noticed. This clinical approach is in accordance with the findings of previous reports assessing the efficacy of the combined treatment of clozapine and sulpiride. The grounds for this treatment regimen using olanzapine rather than clozapine are discussed, calling for further studies to affirm the hypothesis and clinical results.
有人提出，将非典型抗精神病药物奥氮平与选择性D2拮抗剂舒必利联合使用，是治疗难治性持续性精神分裂症患者的一种有效策略。舒必利与奥氮平联合使用（反之亦然）可提高临床疗效，其心理药理学原理在于两种药物对脑受体的亲和力不同。奥氮平的亲和力与5-羟色胺5-HT2的关系比与多巴胺-2的关系更大，而舒必利被认为是一种选择性D2阻滞剂。在奥氮平中加入选择性D2拮抗剂可能通过增强D2阻滞作用而成为奥氮平的增效剂。这种治疗方式应用于6例慢性精神分裂症患者，这些患者临床症状显著且迅速改善，阳性与阴性症状量表及简明精神病评定量表评分降低，且未发现令人困扰的副作用。这种临床方法与先前评估氯氮平与舒必利联合治疗疗效的报告结果一致。文中讨论了使用奥氮平而非氯氮平进行这种治疗方案的依据，呼吁进行进一步研究以证实这一假设和临床结果。
