Second-Generation (Atypical) Antipsychotics and Metabolic Effects

  title={Second-Generation (Atypical) Antipsychotics and Metabolic Effects},
  author={John W. Newcomer},
  journal={CNS Drugs},
Increasing numbers of reports concerning diabetes, ketoacidosis, hyperglycaemia and lipid dysregulation in patients treated with second-generation (or atypical) antipsychotics have raised concerns about a possible association between these metabolic effects and treatment with these medications. This comprehensive literature review considers the evidence for and against an association between glucose or lipid dysregulation and eight separate second-generation antipsychotics currently available… 

Metabolic considerations in the use of antipsychotic medications: a review of recent evidence.

  • J. Newcomer
  • Medicine, Psychology
    The Journal of clinical psychiatry
  • 2007
There is a critical need for psychiatrists and primary care professionals to increase awareness of and attention to the physical health problems of persons with mental illness, including appropriate management of metabolic adverse events associated with psychiatric medications.

Weight Gain and Changes in Metabolic Variables following Olanzapine Treatment in Schizophrenia and Bipolar Disorder

The PubMed database was used to search for publications that included any information on measures of changes in weight, body mass index (BMI) and/or metabolic variables in randomized studies of olanzapine published between 1992 and 2010, with olanZapine appearing to have a greater association than some other atypical antipsychotics.

The Metabolic Effects of Antipsychotic Medications

  • J. NewcomerD. Haupt
  • Medicine, Psychology
    Canadian journal of psychiatry. Revue canadienne de psychiatrie
  • 2006
Substantial evidence indicates that increases in adiposity are associated with decreases in insulin sensitivity in individuals both with and without psychiatric disease, and the effects of increasing adiposity may contribute to increases in plasma glucose and lipids observed during treatment with certain antipsychotics.

Abnormal glucose metabolism in patients treated with antipsychotics Troubles du métabolisme glucidique chez les patients traités par antipsychotiques

Available evidence suggests that clozapine and olanzapine have a higher propensity to induce diabetes and metabolic syndrome compared with other atypical antipsychotic drugs, risperidone and quetiapine, and interestingly, reversibility of drugrelated diabetes has been reported with aripiprazole.

Lithium or Valproate Adjunctive Therapy to Second-generation Antipsychotics and Metabolic Variables in Patients With Schizophrenia or Schizoaffective Disorder

These cross-sectional findings suggest it may be beneficial to monitor insulin sensitivity and body mass index in patients taking lithium or valproate in combination with a second-generation antipsychotic.

Metabolic Findings From the CATIE Trial and Their Relation to Tolerability

The CATIE results show that important distinctions exist among currently available atypical antipsychotics, and Physicians should be aware of the propensity of these drugs to increase the risks of cardiovascular disease and diabetes in treated patients and tailor individual treatment decisions accordingly.

Antipsychotics and metabolics in the post-CATIE era.

Schizophrenia patients have high prevalence of cardiovascular (CV) disease risk factors and high CV mortality, with increasing concern over the contribution of antipsychotic medications to



The effects of novel antipsychotics on glucose and lipid levels.

It has been shown that novel antipsychotics are associated with weight gain and this risk factor along with others, such as elevated glucose and triglyceride levels, compounds the risk for coronary artery disease.

Hyperglycemia and Hypertriglyceridemia in Real World Patients on Antipsychotic Therapy

A retrospective chart review of patients from various clinical settings suggests that the high prevalence of diabetes, lipid abnormalities, and hypertension in a young, chronically psychiatrically ill population makes the case for aggressive screening.

Novel antipsychotics and severe hyperlipidemia.

Clinical monitoring of serum lipids must be added to the concerns about the metabolic consequences of therapy with certain newer antipsychotic agents following treatment with olanzapine or quetiapine.

A review of the effect of atypical antipsychotics on weight

  • H. Nasrallah
  • Psychology, Medicine
  • 2003

Serum leptin and triglyceride levels in patients on treatment with atypical antipsychotics.

The results suggest that leptin may be associated with olanzapine- and clozAPine-induced weight gain and that quetiapine appears to have modest influence and risperidone seems to have minimal influence on leptin and triglyceride levels and weight gain compared with o Lanzapines and clozoapine.

Hyperglycemia and antipsychotic medications.

Patients taking antipsychotic medications should undergo regular monitoring of weight and plasma glucose and lipid levels, so that clinicians can individualize treatment decisions and reduce iatrogenic contributions to morbidity and mortality.

Relationship between levels of insulin or triglycerides and serum concentrations of the atypical antipsychotics clozapine and olanzapine in patients on treatment with therapeutic doses

Investigation of potential relationships between insulin or other hormones related to glucose–insulin homeostasis or lipids and steady-state serum concentrations of clozapine or olanzapine in patients on therapeutic doses found metabolic abnormalities (i.e. hyperinsulinemia, hyperlipidemia and hyperleptinemia) and insulin resistance were associated with both clozAPine and olanZapine treatments.

An assessment of the independent effects of olanzapine and risperidone exposure on the risk of hyperlipidemia in schizophrenic patients.

A strong association between olanZapine exposure and hyperlipidemia in schizophrenic patients is observed and the possible metabolic consequences of olanzapine use should be given serious consideration by treating physicians.