Schizophrenia: Optimal therapy with second-generation antipsychotic agents

Patel, Krina H.; Hlavinka, Peter F.
November 2007
Pharmacy Today;Nov2007, Vol. 13 Issue 11, Special section p73
Objective: To describe symptoms of schizophrenia and present current concepts about optimal use of second-generation, or atypical, antipsychotic agents (SGAs) in its treatment, Data sources: Conducted manually by the authors. Study selection: Not applicable. Data extraction: Not applicable. Data synthesis: Through a variety of positive, negative, cognitive, and mood symptoms, schizophrenia can have a dramatic impact on the patient's life. While quite treatable with medications, schizophrenia is associated with considerable nonadherence, and this is an area of emphasis for pharmacists. SGAs have emerged as first-line treatments for schizophrenia, being favored over first-generation agents because of fewer and less severe adverse effects. However, the SGAs are associated with new-onset metabolic syndrome, including detrimental increases in weight, serum cholesterol, glucose levels, waist circumference, and blood pressure. While psychiatric stabilization is the first priority in patients with schizophrenia, metabolic changes during SGA therapy require monitoring and management, as their long-term sequelae are serious. Changing to an SGA with lower potential for adverse metabolic effects is one option, as is encouraging a healthy diet and exercise program. Some studies show that metformin and topiramate have potential for managing metabolic syndrome in patients taking SGAs. Conclusion: Pharmacists need to take a proactive approach in monitoring patients taking SGAs for schizophrenia and other psychiatric conditions for adherence to and persistence with prescribed therapy and for adverse metabolic effects. Medication changes, along with other options, may need to be considered in order to adequately manage adverse effects.


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