This article examines the adverse effects of antipsychotics

Antipsychotics are first-line treatment for
schizophrenia and other psychiatric disorders.
Antipsychotics are increasingly used to treat a variety of psychiatric disorders, including bipolar disorder, major depressive disorder, obsessive-compulsive disorder, and more
.
However, antipsychotic use is associated
with a range of neurological, metabolic, musculoskeletal, hematologic, endocrine, and other side effects.
These adverse effects can lead to patient non-adherence, adverse outcomes, and impaired
quality of life.
Therefore, the choice of antipsychotic should be determined
by taking into account its side effects.

This is a large-scale study
of antipsychotic-related adverse effects in Asians.
The investigators collected adverse events of antipsychotic drugs reported in South Korea from 2010 to 2019 and reported a total of 5067 cases
.
Of these, 2291 were males (45.
2%) and 2690 females (53.
1%), with a median age of 48 (30-67) years
.
More reports
of adverse reactions were observed in individuals aged 20 to 50 years.
Women experience more
adverse reactions than men in the same age group.

Common adverse reactions were classified systematically, with gastrointestinal disorders being the most common (n = 1815, 35.
8%), followed by central and peripheral nervous system disorders (n = 1436, 28.
3%), psychiatric disorders (n = 1424, 28.
1%), metabolic and nutritional disorders (n = 354, 7.
0%), and skin and its adnexal diseases (n = 287, 5.
7%)
.

Common adverse reactions were ranked by frequency, with constipation (n = 834, 16.
5%) being the most common, followed by dizziness (n = 567, 11.
2%), drowsiness (n = 518, 10.
2%), dry mouth (n = 247, 4.
9%), delirium (n = 247, 4.
9%), nausea (n = 235, 4.
6%), weight gain (n = 228, 4.
5%), leukopenia (n = 204, 4.
0%), and extrapyramidal symptoms (n = 187).
, 3.
7%), hypotension (n = 162, 3.
2%), tremor (n = 162, 3.
2%), tachycardia (n = 159, 3.
1%), etc
.

Common adverse reactions of various antipsychotics are as follows:

Constipation is most common with many medications, such as amsulpiride, aripiprazole, quetiapine, and risperidone
.

Amsulpride, olanzapine, paliperidone, quetiapine, and risperidone often present with hyperprolactinemia
.

Clozapine has a higher frequency of bone marrow abnormalities such as leukopenia, agranulocytosis, and leukocytosis
.

Extrapyramidal symptoms are most common with haloperidol and paliperidone
.

Liver dysfunction was observed in cases of clozapine, haloperidol, olanzapine and risperidone
.

Cardiac symptoms such as arrhythmias, tachycardia and QT prolongation
are observed in paliperidone, quetiapine, haloperidol and amisulpride.

Time of adverse reactions after taking antipsychotic drugs:

Depending on when the adverse effect occurred, most clinical manifestations are present within 1 month of administration, including: gastrointestinal symptoms (e.
g.
, constipation), central nervous system symptoms (e.
g.
, dizziness, drowsiness), and metabolic symptoms (e.
g.
, increased appetite and weight gain).

Cardiovascular symptoms such as hypotension, tachycardia, and QT prolongation also often occur
within 1 month.
However, bone marrow-related symptoms, liver dysfunction, dystonia (including extrapyramidal symptoms), and hyperprolactinemia occur mainly with long-term use for more than
3 months.

Clinical features of adverse reactions in different ages:

The age groups are 0-19 years old (children and adolescents), 20-59 years old (adults) and over 60 years old (seniors).

The incidence of adverse reactions in adults, the elderly, and children and adolescents was 2759 (54.
5%), 1643 (32.
4%), and 395 (7.
8%)
, respectively.
Constipation and dizziness are the most commonly reported adverse events
in adults and older adults.
The most common adverse reactions in children and adolescents are drowsiness and nausea
.
Among adults, the highest number of adverse events reported was quetiapine (38.
8%), followed by clozapine (15.
2%) and olanzapine (12.
9%), with ziprasidone having the lowest number of adverse events (0.
9%)
.
In older people, quetiapine (70.
5%) caused the largest number of adverse effects, followed by olanzapine (8.
6%), risperidone (6.
9%), and haloperidol (6.
2%)
.
In children and adolescents, aripiprazole-related adverse reactions were highest (34.
9%), followed by risperidone (20.
0%)
.

In addition, nausea and drowsiness are common causes of discontinuation in children, adolescents and adults, while the common causes of discontinuation in the elderly are delirium, hypotension, and extrapyramidal disorders
.

The current results suggest that the antipsychotic with the most reported adverse reactions is quetiapine, followed by olanzapine and clozapine
.
Adverse events reported by antipsychotics varied widely
.
The most common adverse reactions were drowsiness in children, constipation in adults, and dizziness
in the elderly.
Gastrointestinal problems and neurological symptoms mainly occur within 1 month of taking the drug, while extrapyramidal symptoms, metabolic symptoms and bone marrow suppression mostly occur after
medium and long-term use of the drug.

References

Oh, S; Byeon, SJ; Chung, SJ, et al.
Characteristics of adverse reactions among antipsychotic drugs using the Korean Adverse Event Reporting System database from 2010 to 2019.
J PSYCHOPHARMACOL.
2022-09-01; 36(9):1041-1050.