RESUMO
Objective:To assess the metabolic side effects of the following atypical antipsychoties head-to-head:amisulpride,olanzapine,aripiprazole,quetiapine,risperidone,ziprasidone.Methods:We searched the MED-LINE,EMBASE,Cochrane Library,PubMed,CNKI,Web of science,Sinomed,WANGFANG DATA databases for randomized,blineded studies comparing the above mentioned atypical antipsychoties in the treatment of schizophre-nia or related disorders.At last three reviewers extracted the data independently.All the data would be analysed with meta ananlysis and the analysis software of the RevMan 5.1 provided by Cochrane network.Results:There were 49 studies in which 45 were written in English and 4 were written in Chinese included in the review.Olanzapine pro-duced statistically significantly more weight gain than all other second-generation antipsychotics.Risperidone pro- duced significantly more weight gain than amisulpride.Olanzapine produced statistically significantly more increase in glucose levels from baseline to endpoint than all other second-genetation antipsychotics.Risperidone produced statistically significantly more increase in glucose levels from baseline to endpoint than aripiprazole,quetiap-ine.Olanzapine produced statistically significantly more increase in cholesterol than aripiprazole,risperidone and zi-prasidone.Quetiapine produced significantly more increase in cholesterol than risperidone and ziprasi-done.Risperidone produced significantly more increase in cholesterol compared to aripiprazole and ziprasidone.Conclusion:Some atypical antipsychoties lead to substantially more metabolic side effects than other a-typical antipsychoties.When choosing an atypical antipsychotic agent for an individual patient these side effects with their potential cause of secondary diseases should be weighed against efficacy and characteristics of the individual patient.
RESUMO
Antipsicóticos atípicos têm sua ação em doses que podem produzir efeitos colaterais importantes. A risperidona é o antipsicótico atípico de nova geração mais utilizado na atualidade e seu uso está associado a tratamento de esquizofrenia, transtornos psicóticos, episódios de mania e nos distúrbios de comportamento, entre outros. Os efeitos adversos mais importantes estão relacionados ao sistema nervoso central e autônomo, sistema endócrino e sistema cardiovascular. Neste último, pode haver efeitos inotrópicos negativos e alterações no eletrocardiograma, como prolongamento do intervalo QT, podendo causar taquicardia e arritmias. Relatamos um caso de um homem de 48 anos com história de delírio persecutório após ser ameaçado no trabalho, que estava sendo tratado com risperidona e paroxetina. Por não haver melhora, suas doses foram aumentadas e o paciente apresentou alargamento do intervalo QTc, com diminuição da amplitude da onda T e aumento da onda U, e hipocalemia. Além disso, o paciente era hipertenso e estava em uso de hidroclorotiazida. A risperidona tem o potencial de bloquear o componente rápido do canal cardíaco de potássio e isso prolonga o processo de repolarização dos ventrículos, podendo causar torsade de pointes, morte súbita e arritmias. Já a hidroclorotiazida causa hipocalemia, provocando alterações na contração e relaxamento do miocárdio. Houve interação medicamentosa grave entre duas drogas com potencial arritmogênico, o que levou às alterações no eletrocardiograma e produziu sintomas danosos ao paciente. A troca do antipsicótico atípico para um típico e da hidroclorotiazida por um diurético que não causa hipocalemia trouxe melhoras ao paciente.
Atypical antipsychotics have their actions in doses that can cause important side effects. The risperidone is the new generation atypical antipsychotic most widely used these days and it is related to the treatment of schizophrenia, psychotic disorders, manic episodes and behavioral disorder, among others. The most significant side effects are associated with the central and autonomic nervous system, endocrine system and cardiovascular system. Considering the latter, negative inotropic effects and changes on eletrocardiograma can occur, with QT-interval prolongation, which can cause tachycardia and arrhythmias. We reported a case of a 48 years old man with history of persecutory delusion after being threatened at work, treated with risperidone and paroxetine. Since there was no improvement, the doses were increased and the patient showed QTc-interval prolongation, with a T-wave amplitude decrease and an increase on the U-wave, in addition to hypokalemia. Besides, the patient was hypertensive and was using hydrochlorothiazide. Risperidone has the potential to block the fast component of the cardiac potassium channel and it extends the repolarization process of the ventricles, which can lead to torsade de pointes, sudden cardiac death and arrhythmias. Also hydrochlorothiazide can cause hypokalemia, with disturbances on the myocardium depolarization and repolarization. There was a serious drug interaction with two potentially arrhythmogenic drugs, which led to the alterations on the electrocardiogram and generated hurtful symptoms to the patient. The shift of the atypical antipsychotic to one typical and of the hydrochlorothiazide to a diuretic that does not cause hypokalemia brought improvements to the patient.