Recognizing and monitoring adverse events of second-generation antipsychotics in children and adolescents

Despite the limited availability of randomized, controlled evidence regarding the efficacy and safety of second-generation antipsychotics (SGAs) in pediatric populations [1,2], this class of medications is being prescribed in escalating rates [3-5]. Of note, SGAs are increasingly prescribed for youngsters with nonpsychotic conditions that are not limited to bipolar mania [6-8]. The increased use of SGAs relative to first-generation antipsychotics (FGAs) is a result of several factors, including the reduced risk for acute [9] and chronic [10] neuromotor side effects, greater efficacy for some symptom domains [11, 12], efficacy for broader target symptoms [13], and possibly, improved compliance [14,15]. Despite these possible advantages, SGAs as a group are more likely than FGAs to lead to weight gain and the related abnormalities in lipid and glucose metabolism. This tendency has caused much concern, as reflected by the ADA Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes [16], because of the known associations between weight gain and obesity with diabetes, dyslipidemia, and hypertension, all of which are leading risk factors for future cardiovascular morbidity and mortality. This article reviews the available data on the most relevant adverse events of SGAs in children and adolescents with the aim of informing antipsychotic prescribing and monitoring practices in this vulnerable population. Adequate monitoring and management and, whenever possible, prevention of side effects is crucial to promote physical and psychologic health, adequate role functioning, attainment of developmental milestones, and treatment compliance.