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May 25, 1984

Combined Use of Different Antipsychotic Drugs

Author Affiliations

Brooklyn, NY

JAMA. 1984;251(20):2657-2658. doi:10.1001/jama.1984.03340440017006

To the Editor.—  This is in reference to the question of whether there are valid instances in which combined use of different antipsychotic agents is indicated, eg, chlorpromazine and haloperidol.1I don't believe that Kimball and Glass explained the rationale of many of the psychiatrists who combine antipsychotics and consequently have to defend this practice from reviewers whose guidelines label it an indicator of inappropriate prescribing. The guidelines are based on the statements of authorities in psychopharmacology cited by the respondents that combined use is "seldom indicated"2 and has "no rational basis."3My letter is intended to describe the rational basis for combined use and some of the indications. The indications are based on two facts. The first, mentioned by the respondents, is that many of the antipsychotics have different adverse effect profiles. The second, which they did not mention, is that the most frequent effects are