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One of the advantages of the second generation antipsychotic medication (SGA's) is their more favorable side effect profile as compared with first generation antipsychotic medications(FGA's) (see below). The older agents are effective against the positive symptoms of psychosis, 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 SGA's  generally more benign than that of the FGA's, specific adverse effects of SGA's differ between drugs. Important adverse effects with some SGA's are EPS, prolactin elevation, and weight gain.

Some adverse events are more easily managed than others.  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 often be managed with patient education and behavioral modification strategies.

When selecting an SGA, 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. Ultimately, Efficacy, tolerability and acceptance are the keys to Effectiveness which in turn leads to Reintegration.

Most Common Side Effects of FGA's and SGA's

FGA's

EPS
Tardive dyskinesia
Orthostatic hypotension
Somnolence
Anticholinergic
Hyperprolactinemia
Weight gain
QTc risk

SGA's

Clozapine

Agranulocytosis
Seizures
Somnolence
Orthostatic hypotension
Weight gain

Risperidone

Dose-dependent EPS
Hyperprolactinemia
Weight gain

Olanzapine

Weight gain
Somnolence

Quetiapine

Hypotension
Dizziness
Somnolence
Weight gain

Ziprasidone

 
Nausea
Abdominal pain
Weight gain? 
Dose-dependent EPS
Somnolence

Aripiprozole

Akathesia

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