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First- and Second-Generation Antipsychotics for Children and Young Adults

Slide: 32 of 43

Adverse Effects: FGAs Compared With SGAs

The evidence from comparisons of first-generation antipsychotics (FGAs) as a class versus second-generation antipsychotics (SGAs) as a class, and for FGAs compared with the SGA clozapine, is insufficient to permit conclusions. Comparisons of haloperidol with two SGAs, olanzapine and risperidone, yielded the following results in a meta-analysis:

In comparisons of haloperidol with olanzapine, a meta-analysis of 4 studies of 132 participants showed that weight is 5.79 kg greater with olanzapine (statistically valid range from 3.0 to 8.6 kg greater); the strength of evidence for this finding is low. In 3 studies of 62 participants, extrapyramidal effects were 3.53-fold more likely with haloperidol (statistically valid range from 1.1-fold to 10.9-fold). No studies measuring sedation were reported.

In comparisons of haloperidol with risperidone, a meta-analysis of 3 studies of 130 participants showed no statistically significant difference in weight (statistically valid range is from 8.9 kg lower to 16.76 kg greater with haloperidol); the strength of evidence for this finding is low. In 1 study of 34 participants, extrapyramidal effects were more severe with haloperidol than with risperidone; the strength of evidence for this finding is low. In 1 study of 24 participants, the risk of sedative effects was 6-fold greater with haloperidol than with risperidone (statistically valid range from 1.5-fold to 24.2-fold); the strength of evidence for this finding is low.

Statistical Abbreviations: 95% CI = 95-percent confidence interval; NSD = no statistically significant difference