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Professional Issues >> Total Wellness
Common Side Effects of Typical
and Atypical Antipsychotics
One of the advantages of the atypical antipsychotics is their more favorable side effect profile as compared with the typical neuroleptics (see below). The older agents are effective against psychotic symptoms but often have treatment-limiting adverse effects, such as substantial extrapyramidal side effects (EPS), tardive dyskinesia, and anticholinergic effects. While the overall side effect profile of the atypical agents is generally more benign than that of the typical neuroleptics, specific adverse effects of the atypical antipsychotics differ between drugs. Important adverse effects with some atypical antipsychotics are EPS, QTc interval prolongation, prolactin elevation, and weight gain.
Some adverse events are more easily managed than others. For example, prolongation of the QTc interval can be dangerous. Concern about QTc risks resulted in the withdrawal of the atypical antipsychotic sertindole from the market in 1998. Other serious adverse effects, such as elevated prolactin levels and EPS, can be managed with medication; however, adding new medication carries the risk of new adverse effects in the patient. Weight gain is an adverse event that occurs to some extent with all antipsychotics; however, it can be managed with patient education and behavioral modification strategies.
When selecting an atypical antipsychotic, the side effect profile should be carefully considered. Agents with side effects that are more easily managed should be selected over those that require additional medication.
Most Common Side Effects of Typical and Atypical Antipsychotics
Typical Neuroleptics8
EPS
Tardive dyskinesia
Orthostatic hypotension
Somnolence
Anticholinergic
Hyperprolactinemia
Weight gain
QTc risk
Clozapinea,b
Agranulocytosis
Seizures
Somnolence
Orthostatic hypotension
Weight gain
Risperidonea,b
Dose-dependent EPS
Hyperprolactinemia
Weight gain
Olanzapinea-c
Weight gain
Somnolence
Quetiapined
Hypotension
Dizziness
Somnolence
Weight gain
Ziprasidoneb,e,f
Dyspepsia
Contsipation
Nausea
Abdominal pain
Weight gain?g
QTc risk?g
Dose-dependent EPS
Somnolence
aData from Casey 1996.2
bData from Allison et al. 1998.3
cData from Sanger et al. 1999.4
dData from Misra et al. 1998.5
eData from Keck et al. 1998.6
fData from Daniel et al. 1999.7
8? = Suggested in litereature, but data not yet sufficient.
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