Published: May 2009

Metabolic effects of antipsychotics

Prescriber Update 30(2): 12
May 2009

Although schizophrenia itself is associated with several adverse metabolic effects it is now clear that all antipsychotics, and in particular some atypical antipsychotics, are associated with adverse effects on weight, blood glucose, and lipid concentrations. All of these adverse effects have long-term consequences in terms of life expectancy.

While the effects of antipsychotics on weight gain may be responsible for the increased risk of diabetes and hyperlipidaemia, a direct effect on glucose metabolism may also occur.

Not all atypical antipsychotics are associated with the same level of risk. Clozapine and olanzapine are considered to cause adverse metabolic effects more frequently than other agents.

Prescribers are advised to monitor all patients taking antipsychotics for adverse metabolic effects.

BPAC1 have published guidance on appropriate monitoring for patients which includes:

Weight gain



Patients with high baseline risk factors for diabetes should be prescribed an antipsychotic with lower risk of adverse metabolic effects where possible. In patients where adverse metabolic effects emerge, antipsychotic treatment should be reviewed and metabolic disturbances actively treated.