title: Clinical pharmacology of atypical antipsychotics: an update.
abstract: This review will concentrate on the clinical pharmacology, in particular pharmacodynamic data, related to atypical antipsychotics, clozapine, risperidone, paliperidone, olanzapine, que¬tiapine, amisulpride, ziprasidone, aripiprazole, asenapine, iloperidone, lurasidone and cariprazine. A summary of their acute pharmacokinetics properties are also reported. Four new second-generation antipsychotics are available: iloperidone, asenapine, lurasidone and in the next future cariprazine. Similar to ziprasidone and aripiprazole, these new agents are advisable for the lower propensity to give weight gain and metabolic abnormalities in comparison with older second-generation antipsychotics such as olanzapine or clozapine. Actually lurasidone seems to be best in terms of minimizing unwanted alterations in body weight and metabolic variables. Therapeutic drug monitoring is not strictly necessary for all of the new antipsychotic drugs because there are no unequivocal data supporting a relationship between plasma drug levels and clinical outcomes or side effects. The exception can be represented by clozapine for which plasma levels of 350-420 ng/ml are reported to be associated with an increased probability of a good clinical response. Also for olanzapine an established therapeutic range (20-50 ng/ml) is proposed to yield an optimal response and minimize side effects.
authors.affiliation: Department of Neuroscience and Mental Health, Pychiatric Unit, Clinical Neuropsychopharmacology Unit, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Mauri
authors.affiliation: Department of Neuroscience and Mental Health, Pychiatric Unit, Clinical Neuropsychopharmacology Unit, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Paletta
authors.affiliation: Department of Neuroscience and Mental Health, Pychiatric Unit, Clinical Neuropsychopharmacology Unit, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Maffini
authors.affiliation: Center for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College Denmark Hill, London SE5 8AF, England.
authors.forename: A
authors.initials: A
authors.lastname: Colasanti
authors.affiliation: Department of Neuroscience and Mental Health, Pychiatric Unit, Clinical Neuropsychopharmacology Unit, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Dragogna
authors.affiliation: Department of Neuroscience and Mental Health, Pychiatric Unit, Clinical Neuropsychopharmacology Unit, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Di Pace
authors.affiliation: Department of Neuroscience and Mental Health, Pychiatric Unit, Clinical Neuropsychopharmacology Unit, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy.
authors.forename: A C
authors.initials: AC
authors.lastname: Altamura