Increased cardiovascular risk with second-generation antipsychotic agent switches.
OBJECTIVE
To model the risk of long-term, adverse cardiovascular events after switching from one second-generation antipsychotic medication (SGA) to another in patients with schizophrenia or schizoaffective disorder.


METHODS
PubMed from 1985 to 2004 using the search terms atypical antipsychotics, obesity, weight, diabetes mellitus, dyslipidemia, hypercholesterolemia, lipids, second generation antipsychotics, antipsychotic agents, schizophrenia, metabolic syndrome, cardiovascular disease, and cardiovascular risk factors.


METHODS
By the authors.


METHODS
By the authors.


RESULTS
The selection of an SGA for an individual patient should be primarily based upon its therapeutic effectiveness. However, when two medications are clinically equivalent with respect to treatment outcomes, other important consequences of the medication choice should be considered. Depending upon the type of SGA switch, the risk of an adverse cardiovascular event may be lower, as when olanzapine is switched to risperidone, or may increase by as much as 33%, as when risperidone is switched to olanzapine or clozapine.


CONCLUSIONS
Cardiovascular risk likely differs depending upon SGA choice, but limited data make it difficult to predict the metabolic changes associated with switching. Prospective controlled studies are needed to describe the cardiovascular consequences of switching among the antipsychotic agents so that evidence-based strategies can be developed for selection of the optimal SGA.
Ried
L Douglas
LD
Pharmacy Health Care Administration, College of Pharmacy, P.O. Box 100496, University of Florida, Gainesville, FL 32610-0496, USA. ried@cop.ufl.edu
Renner
Bernard T
BT
McConkey
Joel R
JR
Bengtson
Michael A
MA
Lopez
Larry M
LM
D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D003920:Diabetes Mellitus / Q000139:chemically induced; D006801:Humans; D008055:Lipids / Q000097:blood; D012306:Risk; D012559:Schizophrenia / Q000188:drug therapy*; D015430:Weight Gain / Q000187:drug effects
D014150:Antipsychotic Agents; D008055:Lipids