Safety and tolerability of antipsychotics

Abstract EN

ntipsychotics are commonly used to treat schizophrenia, bipolar disorders, depression, and other conditions where psychotic symptoms occur.

Antipsychotics are classified as typical first-generation agents (FGAs) or atypical second-generation agents (SGAs) or third generation (Dopamine Partial agonists) and lately recent antipsychotics.

Regulatory agencies have approved their usage in the adult population 18-65 years.

However, these agents are prescribed ‘off-label’ for children and adolescents.

Antipsychotics have special warnings for use in the elderly patients with dementiarelated psychosis that includes an increased risk for fatalities and cerebrovascular events.

Extrapyramidal side effects (EPS) and tardive dyskinesia are a risk with all antipsychotic classes.

Even though antipsychotics can lower seizure threshold, clozapine is the most commonly known for this adverse effect.

The metabolic syndrome associated with the SGAs is well known, and olanzapine most commonly produces weight gain and lipid changes.

Thioridazine and mesoridazine have a ‘black box’ FDA warning due to QTc prolongation and risk for torsades de pointes.

Hematologic disorders such as agranulocytosis are associated with clozapine and specific guidelines for patient monitoring are established.

Both FGAs and SGAs are known to produce elevations from baseline prolactin levels with risperidone and paliperidone and amisulpride.

Aripiprazole was reported to have the least effects on plasma prolactin levels.

Neuroleptic malignant syndrome is an acute medical emergency, and antipsychotic therapy must immediately cease and the patient treated in the hospital