Second-Generation Antipsychotic Tip Sheet - AmeriHealth.com

Second-Generation Antipsychotic Tip Sheet
Second-Generation Antipsychotic Medications
• Risperidone/Risperdal
• Iloperidone/Fanapt
• Risperidone/Risperdal
• Olanzapine/Zyprexa
Consta
• Paliperidone/Invega/Sustenna
• Asenapine/Saphris
• Ziprasidone/Geodon
• Clozapine/Clozaril
• Aripiprazole/Abilify
• Quetiapine/Seroquel
• Lurasidone/Latuda
Medical Issues Related to Second-Generation Antipsychotic Usage in Adults 2, 5
Second-generation antipsychotics may cause abnormal blood work in adults such as:
• Elevated serum glucose • Elevated serum lipid levels • Increased prolactin levels
Conditions experienced may include:
• Weight gain
• Increased abdominal girth
• Increased risk of type 2 diabetes
• Diabetic ketoacidosis
• Cardiovascular side effects
• Sudden death in elderly
Monitoring Patients on Second-Generation Antipsychotic Medications
The American Diabetes Association, the American Psychiatric Association, the American Association of Clinical
Endocrinologists, and the North American Association for the Study of Obesity recommend the following screening measures for
monitoring patients using second-generation antipsychotics. 1
Measure Baseline 4-weeks 8-weeks 12-weeks Annually
Personal/family history X X
Body Mass Index (BMI) X X X X X
Waist circumference X X
Blood pressure X X X
Fasting blood glucose X X X
Fasting lipid profile X X X
• There is also a need to monitor prolactin levels in patients prescribed risperidone, at baseline and follow-up intervals.
• Encourage all patients on second-generation anti-psychotics to follow a healthy diet and engage in a rigorous exercise program.
Both the psychiatric and medical communities have determined that the monitoring for metabolic side effects of secondgeneration
antipsychotics is an important part of patient treatment. There are however, differences in the side-effect profiles of
these agents. According to The American Psychiatric Association Clinical Practice Guideline for the Treatment of Patients with
Schizophrenia (2004) and its Guideline Watch (September 2009), along with other more recently published head-to-head
comparison studies, clozapine and olanzapine are the most likely to lead to weight gain and glucose and lipid abnormalities.
These are followed by quetiapine and then risperidone. Clinical trial data has shown that aripiprazole and ziprasidone are
relatively benign. 3, 6, 7
The Potential Benefits 3 of Second-Generation Antipsychotic Medications:
• Prescribed for a wide variety of uses
• Much reduced neurological sequelae over older agents
• Much less incidence of extrapyramidal symptoms
• Much less incidence of tardive dyskinesia
• Increased effectiveness for some of these agents in treating the negative symptoms of schizophrenia (i.e., clozapine,
olanzapine and risperidone). 8
Issues Related to Use in Children
In 2004, Cooper et al. reported a doubling of the use of this class of medication in children enrolled in TennCare, the state of
Tennessee’s Medicaid program, for diagnoses other than schizophrenia or Tourette’s syndrome. In this study, conducted from
1996 to 2001, the use of second-generation antipsychotics for ADHD, conduct disorder and affective disorders accounted for the
doubled rate of use. 4 Careful consideration of the need for a second-generation antipsychotic, in addition to monitoring weight,
serum glucose, lipid profile and abdominal girth in this population, is imperative in children and adolescents.
©2006-2011 Magellan Health Services. This document is the proprietary information of Magellan. Rev. Rev. 11/12 12/11

Second-Generation Antipsychotic Tip Sheet
Summary
• Second-generation antipsychotics should be used for approved indications
• Second-generation antipsychotics have significant metabolic side effects
• Monitoring can reduce the risk of metabolic side effects.
Practitioners should base selection of antipsychotic medications on individual factors for each patient – e.g., previous response,
side effect susceptibilities, family history, co-morbid conditions, medical vulnerabilities, tolerances and patient
preferences/expectations. 6, 9
These guidelines are not intended to replace a practitioner’s clinical judgment. They are designed to provide information and to assist
practitioners with decisions regarding care. The guidelines are not intended to define a standard of care or exclusive course of
treatment. Health care practitioners using these guidelines are responsible for considering their patients’ particular situations in
evaluating the appropriateness of these guidelines.
1. American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the
Study of Obesity. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care 2004; 27(2):596-601.
2. Straker, D. et al. Cost-effective Screening for the Metabolic Syndrome in Patients Treated with Second-Generation Antipsychotic Medications. American
Journal of Psychiatry 2005; 162:1217-1221.
3. American Psychiatric Association. Clinical Practice Guideline for Treating Schizophrenia 2004.
4. Cooper WO, Hickson GB, Fuchs C. Archives of Pediatric and Adolescent Medicine 2004; 158: 753-759.
5. Hales R, Yudofsky S. Textbook of Clinical Psychiatry 4 th edition. Arlington, Virginia, American Psychiatric Publishing, Inc., 2006.
6. American Psychiatric Association. Guideline Watch (September 2009): Clinical Practice Guideline for Treating Schizophrenia.
7. Leucht S, Komossa K, Rummel-Kluge C, Corves C, Hunger H, Schmid F, Lobos CA, Schwarz S, Davis JM. A Meta-Analysis of Head-to-Head Comparisons
of Second Generation antipsychotics in the Treatment of Schizophrenia. Am J Psychiatry 2009: 166: 152-163.
8. Leucht S, Corves C, Arbter D, Engle RR, Chunbo L, Davis JM. Second- generation versus first-generation antipsychotic drugs for schizophrenia: a metaanalysis.
Lancet 2009; 373: 31-41.
9. Kane JM, Correll CU. Past and Present Progress in Pharmacologic Treatment of Schizophrenia. Clin Psychiatry 71:9, September 2010.
©2006-2011 Magellan Health Services. This document is the proprietary information of Magellan. Rev. Rev. 11/12 12/11