The effects of antipsychotic therapy on serum lipids: A comprehensive review

  • J.M. M
  • Meyer J
  • Koro C
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Abstract

OBJECTIVES: The purpose of this paper is to review the literature since 1970 documenting the effects of antipsychotic agents on serum lipids, including a discussion of possible mechanisms for the observed phenomena, the clinical significance and recommendations for monitoring hyperlipidemia during antipsychotic therapy., RESULTS: High-potency conventional antipsychotics (e.g., haloperidol) and the atypical antipsychotics, ziprasidone, risperidone and aripiprazole, appear to be associated with lower risk of hyperlipidemia. Low-potency conventional antipsychotics (e.g., chlorpormazine, thioridazine) and the atypical antipsychotics, quetiapine, olanzapine and clozapine, are associated with higher risk of hyperlipidemia. Possible hypotheses for lipid dysregulation include weight gain, dietary changes and the development of glucose intolerance., CONCLUSIONS: Given the multiple cardiovascular risk factors seen in patients with schizophrenia, great care must be exercised in the choice of antipsychotic therapy to minimize the medical burden of additional risk imposed by hyperlipidemia. It is recommended that a lipid panel be obtained at baseline in all patients with schizophrenia, annually thereafter for patients on agents associated with lower risk of hyperlipidemia and quarterly in patients on agents associated with higher risk for hyperlipidemia. All patients with persistent dyslipidemia should be referred for lipid-lowering therapy or switched to a less lipid-offending antipsychotic agent.

Author-supplied keywords

  • *Antipsychotic Agents/ae [Adverse Effects]
  • *Hyperlipidemias/bl [Blood]
  • *Hyperlipidemias/ci [Chemically Induced]
  • *Psychotic Disorders/dt [Drug Therapy]
  • *hyperlipidemia/dt [Drug Therapy]
  • *hyperlipidemia/si [Side Effect]
  • *lipid/ec [Endogenous Compound]
  • *neuroleptic agent/ae [Adverse Drug Reaction]
  • *neuroleptic agent/cb [Drug Combination]
  • *neuroleptic agent/cm [Drug Comparison]
  • *neuroleptic agent/ct [Clinical Trial]
  • *neuroleptic agent/do [Drug Dose]
  • *neuroleptic agent/dt [Drug Therapy]
  • *neuroleptic agent/it [Drug Interaction]
  • *neuroleptic agent/pd [Pharmacology]
  • *psychopharmacotherapy
  • *schizophrenia/dt [Drug Therapy]
  • Antipsychotic Agents/cl [Classification]
  • Antipsychotic Agents/tu [Therapeutic Use]
  • Cardiovascular Diseases/me [Metabolism]
  • Cardiovascular Diseases/pc [Prevention & Control]
  • Cholesterol
  • Humans
  • LDL/bl [Blood]
  • Triglycerides/bl [Blood]
  • aripiprazole/ae [Adverse Drug Reaction]
  • aripiprazole/cm [Drug Comparison]
  • aripiprazole/ct [Clinical Trial]
  • aripiprazole/dt [Drug Therapy]
  • aripiprazole/pd [Pharmacology]
  • atypical antipsychotic agent/ae [Adverse Drug Reac
  • atypical antipsychotic agent/cb [Drug Combination]
  • atypical antipsychotic agent/cm [Drug Comparison]
  • atypical antipsychotic agent/ct [Clinical Trial]
  • atypical antipsychotic agent/do [Drug Dose]
  • atypical antipsychotic agent/dt [Drug Therapy]
  • atypical antipsychotic agent/it [Drug Interaction]
  • atypical antipsychotic agent/pd [Pharmacology]
  • butyrophenone/ae [Adverse Drug Reaction]
  • butyrophenone/cb [Drug Combination]
  • butyrophenone/cm [Drug Comparison]
  • butyrophenone/ct [Clinical Trial]
  • butyrophenone/dt [Drug Therapy]
  • butyrophenone/it [Drug Interaction]
  • butyrophenone/pd [Pharmacology]
  • cardiovascular risk
  • chlorpromazine/ae [Adverse Drug Reaction]
  • chlorpromazine/cb [Drug Combination]
  • chlorpromazine/ct [Clinical Trial]
  • chlorpromazine/do [Drug Dose]
  • chlorpromazine/dt [Drug Therapy]
  • chlorpromazine/it [Drug Interaction]
  • chlorpromazine/pd [Pharmacology]
  • clinical trial
  • clopenthixol/ae [Adverse Drug Reaction]
  • clopenthixol/cm [Drug Comparison]
  • clopenthixol/ct [Clinical Trial]
  • clopenthixol/dt [Drug Therapy]
  • clopenthixol/pd [Pharmacology]
  • clozapine/ae [Adverse Drug Reaction]
  • clozapine/cb [Drug Combination]
  • clozapine/cm [Drug Comparison]
  • clozapine/ct [Clinical Trial]
  • clozapine/do [Drug Dose]
  • clozapine/dt [Drug Therapy]
  • clozapine/it [Drug Interaction]
  • clozapine/pd [Pharmacology]
  • diazepam/ae [Adverse Drug Reaction]
  • diazepam/ct [Clinical Trial]
  • diazepam/do [Drug Dose]
  • diazepam/dt [Drug Therapy]
  • diazepam/pd [Pharmacology]
  • diet
  • drug effect
  • drug mechanism
  • drug monitoring
  • drug potency
  • fluperlapine/ae [Adverse Drug Reaction]
  • fluperlapine/ct [Clinical Trial]
  • fluperlapine/dt [Drug Therapy]
  • fluperlapine/pd [Pharmacology]
  • fluphenazine/ae [Adverse Drug Reaction]
  • fluphenazine/cm [Drug Comparison]
  • fluphenazine/dt [Drug Therapy]
  • fluphenazine/pd [Pharmacology]
  • glucose intolerance/si [Side Effect]
  • haloperidol/ae [Adverse Drug Reaction]
  • haloperidol/cb [Drug Combination]
  • haloperidol/cm [Drug Comparison]
  • haloperidol/ct [Clinical Trial]
  • haloperidol/do [Drug Dose]
  • haloperidol/dt [Drug Therapy]
  • haloperidol/it [Drug Interaction]
  • haloperidol/pd [Pharmacology]
  • high density lipoprotein cholesterol/ec [Endogenou
  • high risk patient
  • human
  • hypertriglyceridemia/si [Side Effect]
  • levomepromazine/ae [Adverse Drug Reaction]
  • levomepromazine/ct [Clinical Trial]
  • levomepromazine/dt [Drug Therapy]
  • levomepromazine/pd [Pharmacology]
  • lipid analysis
  • lipid blood level
  • low density lipoprotein cholesterol/ec [Endogenous
  • meta analysis
  • metabolic acidosis/si [Side Effect]
  • metabolic disorder/si [Side Effect]
  • metformin/cb [Drug Combination]
  • metformin/dt [Drug Therapy]
  • metformin/pd [Pharmacology]
  • metformin/po [Oral Drug Administration]
  • monotherapy
  • neurological complication/si [Side Effect]
  • non insulin dependent diabetes mellitus/si [Side E
  • nonhuman
  • olanzapine/ae [Adverse Drug Reaction]
  • olanzapine/cm [Drug Comparison]
  • olanzapine/ct [Clinical Trial]
  • olanzapine/do [Drug Dose]
  • olanzapine/dt [Drug Therapy]
  • olanzapine/pd [Pharmacology]
  • patient monitoring
  • perphenazine/ae [Adverse Drug Reaction]
  • perphenazine/cm [Drug Comparison]
  • perphenazine/ct [Clinical Trial]
  • perphenazine/do [Drug Dose]
  • perphenazine/dt [Drug Therapy]
  • perphenazine/pd [Pharmacology]
  • phenobarbital/ae [Adverse Drug Reaction]
  • phenobarbital/ct [Clinical Trial]
  • phenobarbital/dt [Drug Therapy]
  • phenobarbital/pd [Pharmacology]
  • phenothiazine/ae [Adverse Drug Reaction]
  • phenothiazine/cb [Drug Combination]
  • phenothiazine/cm [Drug Comparison]
  • phenothiazine/ct [Clinical Trial]
  • phenothiazine/do [Drug Dose]
  • phenothiazine/dt [Drug Therapy]
  • phenothiazine/it [Drug Interaction]
  • phenothiazine/pd [Pharmacology]
  • phenytoin/ae [Adverse Drug Reaction]
  • phenytoin/ct [Clinical Trial]
  • phenytoin/do [Drug Dose]
  • phenytoin/dt [Drug Therapy]
  • phenytoin/pd [Pharmacology]
  • practice guideline
  • priority journal
  • propranolol/ae [Adverse Drug Reaction]
  • propranolol/cb [Drug Combination]
  • propranolol/it [Drug Interaction]
  • quetiapine/ae [Adverse Drug Reaction]
  • quetiapine/cb [Drug Combination]
  • quetiapine/cm [Drug Comparison]
  • quetiapine/ct [Clinical Trial]
  • quetiapine/do [Drug Dose]
  • quetiapine/dt [Drug Therapy]
  • quetiapine/pd [Pharmacology]
  • review
  • risk assessment
  • risk factor
  • risk reduction
  • risperidone/ae [Adverse Drug Reaction]
  • risperidone/cm [Drug Comparison]
  • risperidone/ct [Clinical Trial]
  • risperidone/dt [Drug Therapy]
  • risperidone/pd [Pharmacology]
  • side effect/si [Side Effect]
  • thioridazine/ae [Adverse Drug Reaction]
  • thioridazine/cm [Drug Comparison]
  • thioridazine/ct [Clinical Trial]
  • thioridazine/dt [Drug Therapy]
  • thioridazine/pd [Pharmacology]
  • triacylglycerol/cj [Subconjunctival Drug Administr
  • trifluoperazine/ae [Adverse Drug Reaction]
  • trifluoperazine/cm [Drug Comparison]
  • trifluoperazine/ct [Clinical Trial]
  • trifluoperazine/do [Drug Dose]
  • trifluoperazine/dt [Drug Therapy]
  • trifluoperazine/pd [Pharmacology]
  • unindexed drug
  • weight gain
  • ziprasidone/ae [Adverse Drug Reaction]
  • ziprasidone/ct [Clinical Trial]
  • ziprasidone/do [Drug Dose]
  • ziprasidone/dt [Drug Therapy]
  • ziprasidone/pd [Pharmacology]
  • zotepine/ae [Adverse Drug Reaction]
  • zotepine/dt [Drug Therapy]
  • zotepine/pd [Pharmacology]

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Authors

  • Meyer J.M.

  • Jonathan M Meyer

  • Carol E Koro

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