From the Guidelines
Atypical antipsychotics are commonly associated with significant weight gain, which can lead to metabolic changes and increase the risk of developing metabolic syndrome. Many patients taking medications such as olanzapine, clozapine, quetiapine, and risperidone experience significant weight gain, often ranging from 5-20 pounds or more over the course of treatment 1. This weight gain typically begins within the first few weeks of treatment and may continue for months. The mechanism behind this side effect involves multiple pathways, including increased appetite, altered glucose metabolism, and effects on histamine H1 receptors and serotonin 5-HT2C receptors that regulate hunger and satiety.
Some key points to consider when prescribing atypical antipsychotics include:
- Regular monitoring of weight, blood glucose, and lipid profiles is essential to identify potential metabolic changes early on 1.
- Lifestyle interventions, including diet and exercise, are important preventive measures to mitigate weight gain and metabolic changes 1.
- In some cases, switching to a more weight-neutral antipsychotic like aripiprazole, ziprasidone, or lurasidone may be considered if weight gain becomes problematic 1.
- The potential risks and benefits of atypical antipsychotics should be carefully discussed with patients and their families, including the risk of weight gain and metabolic changes 1.
It is also important to note that the risk of weight gain and metabolic changes can vary depending on the specific atypical antipsychotic medication being used, with some medications like clozapine carrying a higher risk of significant weight gain and metabolic changes 1. Overall, weight gain is a common and significant side effect of atypical antipsychotics, and careful monitoring and management are necessary to minimize the risk of metabolic changes and other potential complications.
From the FDA Drug Label
Commonly observed adverse reactions (incidence ≥5% and at least twice the incidence for placebo) were : Schizophrenia: Somnolence, respiratory tract infection. ( 6.1) Manic and Mixed Episodes Associated with Bipolar Disorder: Somnolence, extrapyramidal symptoms, dizziness, akathisia, abnormal vision, asthenia, vomiting. ( 6. 1)
A common side effect of atypical antipsychotics, such as ziprasidone, is somnolence. Other common side effects include:
- Respiratory tract infection
- Extrapyramidal symptoms
- Dizziness
- Akathisia
- Abnormal vision
- Asthenia
- Vomiting 2
From the Research
Common Side Effects of Atypical Antipsychotics
- Weight gain, dyslipidemia, type 2 diabetes (T2D), and high blood pressure are common side effects of atypical antipsychotics, which can lead to metabolic syndrome (MetS) 3, 4, 5, 6, 7
- These side effects can increase the risk of reduced life expectancy and poor adherence to treatment 3
- Atypical antipsychotics can interfere with glucose and lipid homeostasis, leading to metabolic disturbances 3
- The risk of metabolic syndrome varies among different atypical antipsychotics, with olanzapine and clozapine associated with the highest risk, and quetiapine, risperidone, asenapine, and amisulpride causing moderate alterations 3, 4, 7
- Newer atypical antipsychotics, such as ziprasidone, lurasidone, and aripiprazole, may have a more favorable metabolic profile 3
Specific Side Effects
- Weight gain is a common side effect of atypical antipsychotics, and can be highly distressing to patients 6
- Atypical antipsychotics can increase the risk of de novo diabetes mellitus and hypertriglyceridemia 6
- Extrapyramidal symptoms, such as akathisia and tardive dyskinesia, are also common side effects of atypical antipsychotics 4
- Other side effects, such as sedation, hypotension, arrhythmias, and increased prolactin levels, can also occur 5