DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.044

Pages: 1048-1050

Background: Treatment-resistant schizophrenia is most commonly managed with clozapine after failure of two adequate antipsychotic trials. However, clozapine discontinuation or unavailability may expose previously stabilized patients to relapse and creates major therapeutic challenges. Evidence supporting non-clozapine antipsychotic combinations remains limited, and the specific association of haloperidol and aripiprazole has been described only in sparse and conflicting reports. Case presentation: We report the case of a 34-year-old man diagnosed with schizophrenia in 2009 and later classified as having treatment-resistant schizophrenia after multiple unsuccessful antipsychotic trials. He achieved partial stabilization on clozapine 350 mg/day from 2019. In April 2023, clozapine was abruptly discontinued because of medication unavailability in Morocco. Despite treatment with olanzapine 20 mg/day, he developed worsening delusions, auditory hallucinations, negative symptoms, and insomnia, requiring hospitalization. Due to insufficient response and high metabolic risk, olanzapine was replaced by haloperidol 9 mg/day combined with aripiprazole 15 mg/day, later increased to 30 mg/day. Clinical improvement was observed during hospitalization, allowing discharge after one month. PANSS positive scores decreased from 18 to 10 and negative scores from 18 to 11 between April and May 2023, with subsequent patient stability. Conclusion: This case suggests that haloperidol–aripiprazole combination therapy may represent an individualized alternative when clozapine is unavailable, particularly in patients with high metabolic risk. However, the evidence remains insufficient to recommend this strategy routinely, and close clinical, neurological, metabolic, hormonal, and cardiac monitoring is required.