Neuere Antipsychotika

Abstract

In this review we investigate whether sex differences exist for side effects of second-generation antipsychotics. Results are based on a MEDLINE search for the years 1974 through 2005. Even if pharmacokinetics differ between females and males, significantly higher plasma levels for women have been demonstrated only for olanzapine and clozapine. Hyperprolactinaemia is mainly induced by treatment with risperidone and amisulpride, and there is evidence for more pronounced prolactin levels in females. Most studies reviewed indicate that clozapine and olanzapine are associated with more body weight gain, once more especially in female patients. Furthermore, the few published studies indicate that metabolic syndrome is more frequent in females and there are likely no gender-specific differences between the new antipsychotic medications concerning frequency and degree of acute or chronic movement disturbance. The risk of QT prolongation with torsades de pointes arrhythmia is again higher in females. In conclusion, there is some evidence of sex differences in the side effects of second-generation antipsychotics. For better understanding of the basic mechanisms in sex differences, future studies with a primary focus on this topic are required. More specific data will help to determine how these differences shall affect clinical management.

The Complex Relationship between Antipsychotic-Induced Weight Gain and Therapeutic Benefits: A Systematic Review and Implications for Treatment

“…Clinical data has suggested that females may be more susceptible to antipsychotic-associated weight gain as compared to males (Aichhorn et al, 2007 ; Gebhardt et al, 2009 ), although others have failed to demonstrate this association (Basson et al, 2001 ; Ratzoni et al, 2002 ). Nonetheless, we explored the effects of sex in the context of an association between AIWG and therapeutic benefit.…”

Sex Differences in Drug Disposition

“…A comprehensive review of second-generation (atypical) antipsychotics concludes that even though sex differences in cases of adverse events have not been well studied, some adverse effects such as weight gain, hyperprolactinemia, and cardiac effects, are particularly problematic for women [81]. Most studies that were reviewed indicate that clozapine and olanzapine are associated with greater body weight gain than other atypical antipsychotics and that serious adverse effects such as metabolic syndrome (which includes increased visceral adiposity, hyperglycemia, hypertension and dyslipidemia induced by atypical antipsychotics) are more frequent in females.…”

Second International Consensus Study of Antipsychotic Dosing (ICSAD-2)

“…Male patients were described in the present clinical vignettes, although drugs for psychosis may produce larger effect sizes in females ( Rabinowitz et al, 2014 ; Storosum et al, 2023 ), with previous suggestions that doses of drugs for psychosis be decreased by about 10% for female patients ( Gardner et al, 2010 ). There are also sex differences in adverse effect profiles of drugs for psychosis ( Aichhorn et al, 2007 ; Smith, 2010 ) and in the pharmacokinetics of individual agents ( Aichhorn et al, 2007 ). The impact of 17 patient factors on dosing was reported in ICSAD-1 ( Gardner et al, 2010 ).…”