Comparison of Adverse Effects of Newer Atypical Antipsychotics: An Evidence Based Review

Abstract

Aim: To Compare the safety of asenapine and iloperidone as per information available in public domain. Method: In addition to their USFDA approved prescribing information, literature on these two drugs from Pubmed indexed journals in English language were searched for appropriate information. We found 8 relevant articles on asenapine and iloperidone, results of which are discussed in this review. Data on the adverse effects commonly reported for atypical antipsychotics were collected from these articles and compared. Descriptive statistics was used to present the results. Results: Iloperidone is more frequently found to be associated with QTc prolongation (dose dependent), orthostatic hypotension & related dizziness (despite slow up-titration), weight gain and antimuscarinic side effects. On other side, asenapine is more frequently associated with extrapyramidal side effects and akathisia as well as the only one associated with headache, oral hypoesthesia and adverse event related discontinuations. Conclusion: Although, asenapine appears to be less frequently associated with adverse events commonly associated with atypical antipsychotics, complex sublingual dosing and higher discontinuation related to adverse events offsets this safety advantage. More importantly, both these agents require close counselling of patients for adequate compliance and/ or combination with other antipsychotic to achieve optimum antipsychotic efficacy in Indian context. Key words: Adverse events, Antipsychotics, Asenapine, Iloperidone, Extrapyramidal side-effects, Indian context.