Metabolic side-effects of novel antipsychotic drugs

First descriptions of metabolic side-effects of antipsychotic drugs date back to the 1950s when these drugs were introduced. In the meantime, metabolic side-effects have been shown to occur not only during therapy including conventional antipsychotics like chlorpromazine. Presently, similar problems are encountered with application of the novel, so-called atypical antipsychotics. Introduction of atypical antipsychotics in therapy has substantially promoted the treatment of patients with schizophrenia and other psychotic disorders. Major advantage of these drugs in comparison to conventional antipsychotics is lower frequency of extrapyramidal side-effects and hyperprolactinemia, and generally better tolerance. Still, some atipical antipsychotics are associated to body weight gain, occurrence of diabetes, and elevated cholesterol and triglyceride concentrations. This review addresses differences in effect of certain atypical antipsychotics on glucose and insulin homeostasis and lipid metabolism, as well as the question of the rational method of applying antipsychotics that are accompanied by metabolic side-effects. For the first time in Croatia, this article provides recommendations for routine clinical practice, i.e. on the monitoring of metabolic status of patients treated by novel antipsychotics.