Efficacy and Safety of Second-generation Antipsychotics in Schizophrenia Pharmacotherapy: A Comparative Narrative Review

Abstract

Antipsychotic medications are essential in schizophrenia pharmacotherapy, with notable differences in efficacy and safety. This review aims to discuss and compare the differences in efficacy and safety among various second-generation antipsychotic drugs (SGAs). A narrative review was conducted involving the English-based published literature in three scientific databases between 2000 and January 2021: Google Scholar, Scopus, and PubMed. Clozapine is widely considered an effective therapy option in cases of resistance. Maintenance of schizophrenia treatment with paliperidone palmitate was effective and resulted in a longer duration between relapses. The risk of weight gain and diabetes mellitus was increased significantly with clozapine and olanzapine. Risperidone caused neuroleptic malignant syndrome (NMS) and significantly elevated prolactin levels. The extent of safety concerns reported varied by study design. While there were minor differences in the dose-dependent role of SGAs in acute episode treatment, there were significant differences in the type and intensity of side effects, and hence adherence determinants.