Clinical recommendation | Evidence rating | References |
---|---|---|
FGAs with lower potency dopamine D2 neuroreceptor blockade (Table 1) are no more likely than most SGAs to cause extrapyramidal symptoms. | A | |
FGAs and the SGA risperidone (Risperdal) commonly cause hyperprolactinemia. Physicians should be vigilant for signs and symptoms of hyperprolactinemia in patients taking these medications. | C | |
Patients taking SGAs, especially clozapine (Clozaril) and olanzapine (Zyprexa), should be monitored closely for weight gain and other metabolic syndrome–related adverse effects (Table 4). | C | |
Antipsychotic medications should be used with caution in older adults because of the risk of increased mortality from sudden cardiac death and cerebrovascular accidents. | A |
FGAs = first-generation antipsychotics; SGAs = second-generation antipsychotics.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.xml.