Antipsychotic Receptor Binding Properties

The American Psychiatric Association’s Guideline for Treatment of Patients with Schizophrenia was published in 2021. Table 5 – Antipsychotic Receptor Binding Profiles – provides a detailed chart comparing all antipsychotics.

Regarding LAIs, we will describe two examples for which using Table 5 could be helpful:

1. A person is taking an oral antipsychotic medication and would like to switch to an LAI. This patient has responded well to the oral formulation of the antipsychotic they have been taking, but an LAI formulation is not available. This table would allow a clinician to help selecting a comparable antipsychotic based on similar receptor binding properties.
2. A patient has refractory positive symptoms of psychosis and is taking an LAI at the maximum recommended dose (with therapeutic plasma levels). They tried clozapine in the past but are unable or unwilling to take it again. Using the receptor binding properties of the antipsychotics found in this table, the clinician could select a second antipsychotic with properties that does not duplicate the first LAI. Please note, the literature on combining two, non-clozapine antipsychotics is often mixed. Combining antipsychotics may be helpful specifically augmenting clozapine for a person with treatment resistant schizophrenia and a partial clozapine response.

REFERENCES

• American Psychiatric Association. (2021). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. American Psychiatric Association Publishing (3^rd ed.). https://doi.org/10.1176/appi.books.9780890424841
• Wagner E, Löhrs L, Siskind D, Honer WG, Falkai P, Hasan A. Clozapine augmentation strategies – a systematic meta-review of available evidence. Treatment options for clozapine resistance. Journal of Psychopharmacology. 2019;33(4):423-435. doi:10.1177/0269881118822171