Use of amisulpride in clozapine-resistant schizophrenic patients: Three case reports

Introduction It is generally accepted that Clozapine is the gold standard treatment in patients with treatment resistant schizophrenia. Large numbers of patients treated with Clozapine discontinue treatment for various reasons including severe side-effects and insufficient response. There is limited literature supporting the next-step treatment option following the discontinuation of Clozapine. Objectives The atypical antipsychotic Amisulpride as a next-step treatment option beyond Clozapine, is hypothesised to be useful in some patients due to its first pass metabolism which differs from other second generation antipsychotics. The authors present the clinical response from using Amisulpride in three Clozapine-resistant schizophrenic patients. Aims The authors aim to demonstrate the role of Amisulpride monotherapy in patients with schizophrenia who are resistant to, Clozapine. Method Three cases of individuals with residual psychotic symptoms despite Clozapine use and/ or with significant side effects precipitating discontinuation, are presented. They were changed to Amisulpiride and their response was evaluated by clinical assessment. Results Positive clinical results were obtained in all three patients, with improvement of psychotic symptoms and of some of the more common side effects of Clozapine. Conclusion The findings from these cases suggest that Amisulpride can be of benefit in treating Clozapine-resistant schizophrenic patients. Further, more structured trials are needed to understand these findings.