An update of safety of clinically used atypical antipsychotics

ABSTRACT

Introduction: The atypical antipsychotic (APs) drugs have become the most widely used agents to treat a variety of psychoses because of their superiority with regard to safety and tolerability profile compared to conventional/‘typical’ APs.

Areas covered: We aimed at providing a synthesis of most current evidence about the safety and tolerability profile of the most clinically used atypical APs so far marketed. Qualitative synthesis followed an electronic search made inquiring of the following databases: MEDLINE, Embase, PsycINFO and the Cochrane Library from inception until January 2016, combining free terms and MESH headings for the topics of psychiatric disorders and all atypical APs as following: ((safety OR adverse events OR side effects) AND (aripiprazole OR asenapine OR quetiapine OR olanzapine OR risperidone OR paliperidone OR ziprasidone OR lurasidone OR clozapine OR amisulpride OR iloperidone)).

Expert opinion: A critical issue in the treatment with atypical APs is represented by their metabolic side effect profile (e.g. weight gain, lipid and glycaemic imbalance, risk of diabetes mellitus and diabetic ketoacidosis) which may limit their use in particular clinical samples. Electrolyte imbalance, ECG abnormalities and cardiovascular adverse effects may recommend a careful baseline and periodic assessments.

KEYWORDS:

• Atypical antipsychotic
• antipsychotic
• safety
• tolerability
• adverse events
• side effects

Article highlights

• The atypical antipsychotics show a better safety profile, particularly regarding extrapyramidal symptoms (EPS)

• Atypical antipsychotics have been associated with a greater risk of metabolic adverse events, such as weight gain, lipid and glycaemic alterations, metabolic syndrome and subsequent complications

• Before starting the treatment with atypical antipsychotics has been suggested to weight patient, track BMI during treatment; get waist circumference, blood pressure, fasting plasma glucose and lipid profile.

• An ECG should be performed before starting the treatment as well during the titolation and maintenance period

• It is recommended to carefully monitor leucocitary values and ECG during the treatment with clozapine.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.