From the FDA Drug Label
Atypical antipsychotic drugs have been associated with metabolic changes that may increase cardiovascular/cerebrovascular risk. These metabolic changes include hyperglycemia, dyslipidemia, and body weight gain. While all of the drugs in the class have been shown to produce some metabolic changes, each drug has its own specific risk profile There have been few reports of hyperglycemia or diabetes in patients treated with ziprasidone Although fewer patients have been treated with ziprasidone, it is not known if this more limited experience is the sole reason for the paucity of such reports
The antipsychotic medication with the least cardiovascular risks is not explicitly stated in the provided drug label. However, based on the information provided, ziprasidone may have a lower risk of cardiovascular events due to its lower incidence of hyperglycemia and diabetes mellitus compared to other atypical antipsychotics. Key points to consider:
- Metabolic changes: Atypical antipsychotics, including ziprasidone, can cause metabolic changes that increase cardiovascular risk.
- Hyperglycemia and diabetes: Ziprasidone has a lower incidence of hyperglycemia and diabetes compared to other atypical antipsychotics.
- Cardiovascular risk: The exact cardiovascular risk profile of ziprasidone is not fully understood, but its lower incidence of metabolic changes may indicate a lower risk. 1
From the Research
Aripiprazole (Abilify) generally has the least cardiovascular risks among antipsychotic medications, as supported by the most recent study from 2023 2. This second-generation antipsychotic has a more favorable cardiovascular profile compared to other options, with minimal effects on QT interval prolongation, blood pressure, and weight gain. Aripiprazole works differently from other antipsychotics as a partial dopamine agonist rather than a pure antagonist, which contributes to its reduced side effect profile. The typical starting dose is 10-15 mg once daily, which can be adjusted based on response and tolerability up to 30 mg daily. Some key points to consider when prescribing aripiprazole include:
- Monitoring patients for potential side effects, especially during the initial treatment period
- Considering individual patient factors, including age, existing cardiovascular conditions, and medication interactions
- Being aware of the potential for QT interval prolongation, although this risk is lower with aripiprazole compared to other antipsychotics Other antipsychotics with relatively lower cardiovascular risk include lurasidone (Latuda) and brexpiprazole (Rexulti), though they may not be as well-tolerated as aripiprazole for all patients, as noted in a study from 2018 3 and a review of its pharmacological properties 4. However, the most recent and highest quality study from 2023 2 suggests that lurasidone is actually associated with the lowest risk of QT prolongation reporting, followed by aripiprazole and brexpiprazole. Therefore, when considering the cardiovascular risks associated with antipsychotic medications, lurasidone (Latuda) may be considered as an alternative to aripiprazole, especially in patients at high risk for torsade, as suggested by a systematic review with a meta-analytic approach from 2015 5.