Second-generation antipsychotics for schizophrenia: a review of clinical pharmacology and medication-associated side...

Second-generation antipsychotics (SGAs) are replacing traditional antipsychotics as first line therapy for the treatment of schizophrenia. While recent evidence suggests similar efficacy with low dose conventional antipsychotics, much of the advantage favoring SGAs comes from the fact that there are fewer extrapyramidal side effects (EPS) at effective doses with these drugs. As a medication class and with the exception of clozapine, the SGAs overall are very similar with regard to efficacy yet are heterogeneous with regard to receptor binding and structure-activity as well as their side effect liabilities. This paper will review the clinical psychopharmacology of the SGAs as well as adverse events associated with these drugs. Because certain side effects may be associated with nonadherence with treatment, more detailed data for each of the SGA with regards to EPS, weight gain and metabolic abnormalities and sexual dysfunction are presented.