MINIMIZING THE NON-EXTRAPYRAMIDAL SIDE-EFFECTS OF ANTIPSYCHOTICS

Standard neuroleptic medications have been augmented by the introducti on of risperidone and clozapine into clinical practice. A great deal o f attention has also been focused on efficacy and the lower propensity to extrapyramidal side-effects associated with the new agents. Howeve r, antipsychotic medication, both old and new, can cause a range of ot her adverse effects, some of which are serious, and many of which have the potential greatly to diminish the quality of life of patients who need to take medication in the long term. Of particular significance are postural hypotension, cardiotoxicity, peripheral and central antic holinergic effects, sedation, weight gain, and endocrine and haematolo gical effects. Various antipsychotic compounds differ substantially wi th regard to propensity to adverse effects. Side-effects can be minimi zed by optimization of clinical strategies, including choice of approp riate drug, slow titration and dosage reduction. It is also vital to e xplain carefully to both patients and carers the nature of the side-ef fects which can be anticipated. The choice of antipsychotic is often d etermined by evaluation of the potential impact of the various adverse effects on a particular patient. New drugs, such as risperidone, are well tolerated, with fewer side-effects, and should now be considered as a first-line option.