Pipamperone, also known as carpiperone and floropipamide or fluoropipamide, and as floropipamide hydrochloride is the only typical antipsychotic with proven superiority in the treatment of refractory schizophrenia. It is or has been marketed under brand names including Dipiperon, Dipiperal, Piperonil, Piperonyl, and Propitan. Pipamperone increases antipsychotic efficacy and decrease the distress inflicted by other antipsychotics. Various antipsychotics have been proposed as augmenting agents to pipamperone, with modest benefit, at best. The combination therapies had been considered after a trial of monotherapy with pipamperone at the highest dose (900 mg/d) and proven to be unsuccessful or not tolerated; the augmentation attempts should be abandoned after 3 to 6 months if no improvement is seen or adverse effects become untolerable. Pipamperone, the first typical antipsychotic, has antagonist actions at dopaminergic D1, D2, D3, D4 and serotonergic 5HT-2A, 5HT-2C,

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