Adverse Effects of the Atypical Antipsychotics

Adverse effects of antipsychotics often lead to noncompliance. Thus, clinicians should address patients’ concerns about adverse effects and attempt to choose medications that will improve their patients’ quality of life as well as overall health. The side effect profiles of the atypical antipsychoticsare more advantageous than those of the conventional neuroleptics. Conventional agents are associatedwith unwanted central nervous system effects, including extrapyramidal symptoms (EPS), tardivedyskinesia, sedation, and possible impairment of some cognitive measures, as well as cardiac effects,orthostatic hypotension, hepatic changes, anticholinergic side effects, sexual dysfunction, andweight gain. The newer atypical agents have a lower risk of EPS, but are associated in varying degreeswith sedation, cardiovascular effects, anticholinergic effects, weight gain, sexual dysfunction, hepaticeffects, lowered seizure threshold (primarily clozapine), and agranulocytosis (clozapine only). Sincethe incidence and severity of specific adverse effects differ among the various atypicals, the clinicianshould carefully consider which side effects are most likely to lead to the individual’s dissatisfactionand noncompliance before choosing an antipsychotic for a particular patient.