📊 Side Effect Matrix of Atypical Antipsychotics

[Maggi]

Inhalt

• Visual Side Effect Matrix of Atypical Antipsychotics
• Legend
• Side Effect Matrix of Atypical Antipsychotics
• Legend
• Side Effect Matrix of Atypical Antipsychotics (Rotated Format)
• Legend

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Visual Side Effect Matrix of Atypical Antipsychotics​

Rough orientation values, will be revised in more detail

Side Effect	Lurasidone	Brexpiprazole	Cariprazine	Ziprasidone	Aripiprazole	Amisulpride	Paliperidone	Risperidone	Quetiapine	Olanzapine	Clozapine
Weight Gain¹	+0.3 kg	+0.6 kg	+0.4 kg	+0.5 kg	+0.75 kg	+2.5 kg	+1.8 kg	+2.1 kg	+2.9 kg	+4.1 kg	+4.5 kg
Sedation	mild	mild	mild	mild	mild	moderate	moderate	moderate	strong	very strong	very strong
Prolactin↑	low	low	minimal	minimal	none	high	high	high	moderate	moderate	low
QTc Prolongation	low	low	low	high	low	low	high	high	low	low	low
Akathisia	high	moderate	high	high	high	moderate	high	high	moderate	moderate	none
Parkinsonism	moderate	moderate	moderate	moderate	moderate	high	moderate	high	moderate	moderate	moderate
Tardive Dyskinesia	moderate	moderate	moderate	moderate	moderate	high	moderate	high	moderate	moderate	high
Diabetes Risk	none	low	none	none	none	moderate	moderate	moderate	moderate	high	high
Orthostatic Dysreg.	moderate	moderate	moderate	moderate	moderate	moderate	moderate	moderate	high	high	high
Hypertension	low	low	low	none	low	moderate	high	high	low	moderate	moderate
Constipation	low	low	low	low	low	moderate	moderate	moderate	moderate	high	very high
Salivation	none	none	none	none	none	moderate	moderate	moderate	none	moderate	very high

Legend​

•  = Low / Well tolerated
•  = Mild / Noticeable
•  = Moderate / Clinically relevant
•  = High / Frequently problematic
• ¹ Weight gain over ~6 weeks (median), based on Pillinger et al. (2019)

Side Effect Matrix of Atypical Antipsychotics​

Based on median values over ~6 weeks; clinical experience and S3 guidelines

Drug	Weight Gain¹	Sedation	Prolactin↑	QTc↑	Akathisia	Parkinsonism	Tardive Dyskinesia	Diabetes Risk	Orthostatic Dysreg.	Hypertension	Constipation	Salivation
Lurasidone	+0.3 kg	+	+	+	++	+	+	0	+	0/+	0/+	0
Brexpiprazole	+0.6 kg	+	+	+	+	+	+	0/+	+	0/+	0/+	0
Cariprazine	+0.4 kg	+	0/+	+	++	+	+	0	+	0/+	0/+	0
Ziprasidone	+0.5 kg	+	0/+	++	++	+	+	0	+	0	0/+	0
Aripiprazole	+0.75 kg	+	0	+	++	+	0	+	0/+	0/+	0/+	0
Amisulpride	+2.5 kg	++	+++	+	+	++	++	+	+	+	+	+
Paliperidone	+1.8 kg	++	+++	++	++	+	+	+	+	++	+	+
Risperidone	+2.1 kg	++	+++	++	++	++	++	+	++	+	+	+
Quetiapine	+2.9 kg	++	+	+	+	+	+	+	0/+	+	+	0
Olanzapine	+4.1 kg	+++	++	+	+	+	+	++	++	++	++	+
Clozapine	+4.5 kg	+++	+	+	0	+	++	++	++	+	+++	+++

Legend​

• + / ++ / +++: Mild / Moderate / Severe side effect
• 0 / 0+: None to minimal effect or unclear data
• QTc↑: Prolonged QT interval (cardiac risk)
• Prolactin↑: Hormonal elevation (can affect libido, menstruation)
• Orthostatic Dysregulation: Drop in blood pressure when standing
• Constipation: Often due to anticholinergic effects
• Salivation: Excessive drooling, especially with Clozapine
• Weight Gain¹: Median over ~6 weeks (Pillinger et al., 2019)

Side Effect Matrix of Atypical Antipsychotics (Rotated Format)​

Side Effect	Lurasidone	Brexpiprazole	Cariprazine	Ziprasidone	Aripiprazole	Amisulpride	Paliperidone	Risperidone	Quetiapine	Olanzapine	Clozapine
Weight Gain (6 wks)	+0.3 kg	+0.6 kg	+0.4 kg	+0.5 kg	+0.75 kg	+2.5 kg	+1.8 kg	+2.1 kg	+2.9 kg	+4.1 kg	+4.5 kg
Sedation	+	+	+	+	+	++	++	++	++	+++	+++
Prolactin Elevation	+	+	0/+	0/+	0	+++	+++	+++	+	++	+
QTc Prolongation	+	+	+	++	+	+	++	++	+	+	+
Akathisia	++	+	++	++	++	+	++	++	+	+	0
Parkinsonism	+	+	+	+	+	++	+	++	+	+	+
Tardive Dyskinesia	+	+	+	+	0	++	+	++	+	+	++
Diabetes Risk	0	0/+	0	0	0	+	+	+	+	++	++
Orthostatic Dysreg.	+	+	+	+	0/+	+	+	+	++	++	++
Hypertension	0/+	0/+	0/+	0	0/+	+	++	++	0/+	+	+
Constipation	0/+	0/+	0/+	0/+	0/+	+	+	+	+	++	+++
Salivation	0	0	0	0	0	+	+	+	0	+	+++

Legend​

• + / ++ / +++: Mild / Moderate / Severe side effect
• 0 / 0+: None to minimal effect or unclear data
• Weight Gain: Median over ~6 weeks (Pillinger et al., 2019)
• QTc↑: Prolonged QT interval (cardiac risk)
• Prolactin↑: Hormonal elevation (e.g. libido, menstruation)
• Orthostatic Dysregulation: Drop in blood pressure when standing
• Salivation: Excessive drooling, especially with Clozapine