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How do you manage the 4 most common adverse effects of antipsychotic medications?
Andrew J. Cutler, MD, of SUNY Upstate Medical University and the Neuroscience Education Institute (NEI) presented on the management of the most common adverse effects of antipsychotic medications at the 2021 NEI Congress Friday, November 5, in Colorado Springs, Colorado.
In his presentation, titled “Safety First: A Comparison of the Safety and Tolerability of Antipsychotics,” Cutler discussed the 4 most common adverse effects of antipsychotics that can negatively affect treatment adherence—metabolic problems, movement disorders, sedation, and sexual dysfunction1—as well as some treatment strategies medical providers can use to optimize the management of these adverse effects according to individual patient needs.
To manage metabolic problems, Cutler recommended monitoring metabolic parameters, weight gain, and appetite changes; encouraging a healthy diet and active lifestyle; choosing agents with lower incidents of weight gain when possible (eg, aripiprazole, lurasidone); considering the incorporation of metformin when initiating treatment with olanzapine or clozapine; or using olanzapine with samidorphan instead of olanzapine alone. For movement disorders, he suggested some specific strategies for drug-induced parkinsonism (DIP) and akathisia, which both may be mitigated by reducing dosage or switching to medications with lower risk (eg, clozapine, iloperidone, lumateperone) when possible. Introducing adjunctive medications (eg, beta-adrenergic blockers, benzodiazepines) may also be helpful in cases of akathisia. For sedation, he recommended consolidating antipsychotic medication doses into once-daily doses; identifying any potential interactions between the antipsychotics and other medications the patient may be taking; ruling out comorbid disorders that may be contributing to the sedation; and switching to antipsychotics with a lower risk of sedation (eg, lumateperone, pimavanserin) when possible. Finally, for sexual dysfunction, he suggested selecting an antipsychotic agent with lower likelihood of elevating prolactin (eg, lurasidone, quetiapine) or lowering prolactin (eg, brexpiprazole, cariprazine); considering adding low doses of aripiprazole to another antipsychotic that is causing sexual dysfunction and hyperprolactinemia; and incorporating psychosocial strategies such as relationship counseling and psychoeducation.1
“Medications used to treat psychosis may be the single most powerful tool in a clinician’s armamentarium for reducing antipsychotic-induced adverse effects,” Cutler said in his presentation. Cutler is a clinical associate professor in the SUNY Upstate Medical University Department of Psychiatry, and chief medical officer for NEI. He is board certified in internal medicine by the American Board of Internal Medicine and in psychiatry by the American Board of Psychiatry and Neurology.
1. Cutler AJ. Safety first: a comparison of the safety and tolerability of antipsychotics. Presented at 2021 NEI Congress. November 5, 2021.