Adverse effects of antipsychotic drugs

Introduction to this topic

Professor David Owens
Professor of Clinical Psychiatry, University of Edinburgh

Updated: Wednesday, 27th April 2011
Last Checked: Wednesday, 18th October 2017 Current

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In addition to their therapeutic effect mediated by region-specific antagonism of dopamine D2 receptors (the “target” action), antipsychotic drugs generally have additional, often multiple, “non-target” actions. All actions not directly mediating the therapeutic action are side-effects, and many of these are clinically adverse. After introducing these general principles, this topic illustrates them using three important areas. First, a range of cardiovascular actions are described, including QTc prolongation and other potential mechanisms of increased mortality, as well as increased risk of cerebrovascular events. The second describes the metabolic syndrome of weight gain, atherogenic dyslipidaemias, hypertension and impaired glucose tolerance. Third, adverse motor (“extrapyramidal”) effects of D2 receptor antagonism in non-target regions are described, with a particular emphasis on parkinsonism.

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