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Adverse metabolic effects associated with atypical antipsychotics: literature review and clinical implications
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Pharmacogenetics)
2004 (English)In: Drugs, ISSN 0012-6667, Vol. 64, no 7, 701-23 p.Article in journal (Refereed) Published
Abstract [en]

Adverse metabolic effects, such as diabetes mellitus, lipid abnormalities and weight gain, have increasingly been recognised with the use of the newer, so-called atypical antipsychotic drugs. This article reviews the current literature in the field and attempts to answer the question of whether the atypical antipsychotics differ in their effects on glucose-insulin homeostasis and lipid metabolism. It also addresses how then to manage the use of the atypical antipsychotics that do interfere with these metabolic systems. Differences in effects of atypical antipsychotics on leptin levels are also summarised and put into context; bodyweight gain associated with atypical antipsychotics is reviewed elsewhere.In summary, there are no large controlled trials published quantifying the prevalence of adverse effects on glucose-insulin homeostasis and lipid metabolism in patients receiving atypical antipsychotics. Nevertheless, the published articles and case reports reviewed in this article give a fairly good view of those adverse effects occurring with clozapine, olanzapine and risperidone, whereas little data are available regarding quetiapine, ziprasidone and zotepine, and no data exist for amisulpride and aripiprazole. Estimated rankings of the atypical agents, based on the available literature, show that the relative risk of glucose intolerance/diabetes mellitus, hyperlipidaemia and hyperleptinaemia is highest for clozapine and olanzapine, moderately high for quetiapine, rather low for risperidone and lowest for ziprasidone. Since adverse metabolic effects of atypical antipsychotics may have a negative influence on both the antipsychotic treatment outcome as well as the physical health of the patient, these effects have to be recognised and adequately managed. In this review, recommendations for prevention and treatment of the adverse metabolic effects are outlined.

Place, publisher, year, edition, pages
2004. Vol. 64, no 7, 701-23 p.
Keyword [en]
Antipsychotic Agents/*adverse effects/therapeutic use, Glucose Metabolism Disorders/chemically induced/complications/prevention & control, Humans, Hyperlipidemia/chemically induced/complications/prevention & control, Leptin/biosynthesis/blood, Research Support; Non-U.S. Gov't, Treatment Outcome
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-73046PubMedID: 15025545OAI: oai:DiVA.org:uu-73046DiVA: diva2:100957
Available from: 2005-05-31 Created: 2005-05-31 Last updated: 2009-07-09Bibliographically approved

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