Metabolic, neurological and endocrine safety profiles of atypical antipsychotics: focus on quetiapine, olanzapine and risperidone: an updated review

Abstract

The atypical antipsychotics (second-generation antipsychotics, SGAs) are commonly used in the treatment of schizophrenia, bipolar disorder and other mental illnesses because they have fewer extrapyramidal side effects than first-generation agents. Nonetheless, their growing utilization has brought to light serious safety issues, especially in metabolic, neurological and endocrine spheres. This review aims at comparing three widely used SGAs, which are Quetiapine, Olanzapine, and Risperidone, with comparison in their pharmacological and safety profiles. Olanzapine presents the greatest metabolic risk often leading to weight gain, dyslipidaemia and insulin resistance. Quetiapine exhibits less sensitive metabolic responses accompanied by reduced pyramidal and prolactin increase rates at low off-label doses but is risky. Risperidone is an effective treatment of psychotic and bipolar disorders, but it is closely linked to hyperprolactinemia and dose-related extrapyramidal symptoms. The review also points out that there is now emerging evidence on changes in gut microbiota and changes in pharmacogenetic variations that affect individual response to drug and drug adverse effects. In general, the results highlight the importance of identifying unique antipsychotic treatment, regular checks of metabolic, endocrine indicators to ensure optimal safety and treatment. It is recommendable that future studies concentrate on genetic predictors, new formulations (e.g. olanzapine-samidorphan), and microbiome-targeted interventions as a way of reducing adverse effects