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First- and Second-Generation Antipsychotics for Children and Young Adults
Authors: John H. Coverdale, MD, MEd
Conclusions About Benefits and Adverse Effects of Antipsychotics (2 of 2)
- Adverse effects of second-generation antipsychotics (SGAs) include extrapyramidal symptoms (EPS), somnolence, weight gain, dyslipidemia, and elevated prolactin levels.
- In head-to-head comparisons of SGAs, the risk and severity of abnormalities of weight and blood lipids are greatest with olanzapine.
- Risperidone raises prolactin levels more than olanzapine.
- There is low-strength evidence of no differences between SGAs in effects on insulin and glucose control, EPS, and sedation.
- The long-term safety of both FGAs and SGAs and their effectiveness for improving quality-of-life outcomes are not established.
- Although SGAs have been perceived as having fewer side effects than FGAs, data are very limited to compare the relative risks of adverse effects. The spectrum of adverse effects should be taken into account, along with possible alternatives, when considering use of these drugs.
- Seida J, Schouten J, Mousavi S, et al. First- and Second-Generation Antipsychotics for Children and Young Adults. Comparative Effectiveness Review No. 39 (Prepared by the University of Alberta Evidence-based Practice Center under Contract No. 290-2007-10021). Rockville, MD: Agency for Healthcare Research and Quality; February 2012. AHRQ Publication No. 11(12)-EHC077-EF. Available at www.effectivehealthcare.ahrq.gov/pedantipsych.cfm.
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