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Metabolic and Cardiac Side Effects of Second-generation Antipsychotics: What Every Clinician Should Know

From the Department of Pharmacy, Virginia Commonwealth University Health System, Richmond, Virginia (ELB); Ernest Mario School of Pharmacy, Department of Pharmacy Practice and Administration, Rutgers, The State University of New Jersey, Piscataway, New Jersey (MTL); and Department of Pharmacy, Virginia Commonwealth University Health System, Richmond, Virginia (SRD).

Correspondence: Ericka L. Breden, VCUHS, Department of Pharmacy, 401 N 12th St, PO Box 980042, Richmond, VA 23298; e-mail: ebreden{at}mcvh-vcu.edu.

In 2007, 5 of the 7 second-generation antipsychotics were listed in the Top 200 Drugs prescribed by retail sales in the United States. Cardiovascular disease is the leading cause of natural death in individuals with schizophrenia. Second-generation antipsychotics have been implicated with metabolic and cardiovascular adverse effects, and it is important for nonpsychiatric practitioners to be familiar with the monitoring parameters recommended for these agents. This article discusses the risk of weight gain, hyperglycemia, hyperlipidemia, hyperprolactinemia, and cardiovascular concerns associated with second-generation antipsychotic agents. It also discusses the proposed mechanisms for each of these adverse effects. Furthermore, it reviews suggested monitoring parameters to help manage cardiovascular disease in this patient population, and to improve the gap that exists between mental health care and physical health care in the schizophrenic population.

Key Words: atypical antipsychotic • metabolic • cardio-vascular • hyperprolactinemia • monitoring

This version was published on October 1, 2009

Journal of Pharmacy Practice, Vol. 22, No. 5, 478-488 (2009)
DOI: 10.1177/0897190008330200


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