This ‘optimal use’ project from the Canadian Agency for Drugs and Technologies in Health assesses the clinical and economic impact of using atypical antipsychotic combination therapy, as well as high-dosing treatment strategies, in adolescents and adults with schizophrenia.

The report was produced by an expert panel who based their recommendations on a systematic review and meta-analysis of the evidence, as well as a review of the current utilisation data.

The key messages from the report are that when a patient with schizophrenia is not adequately responsive to an antipsychotic agent:

• Increasing the dose (within the recommended range), or switching to a different antipsychotic agent is recommended — switching to clozapine should be considered as an option
• High-dose strategies or combining atypical antipsychotic drugs with other antipsychotic agents are not known to be more effective and may be more harmful than treatment with a recommended dose of one antipsychotic agent

Optimal use recommendations for atypical antipsychotics: combination and high-dose treatment strategies in adolescents and adults with schizophrenia (PDF). Canadian Agency for Drugs and Technologies in Health, Dec 2011.