Expert group recommendations on the use of antipsychotic drugs in patients with somatic diseases. Part I: (metabolic syndrome, cardiovascular diseases)

Antipsychotic drugs/antipsychotics as a group, despite their similar clinical effect, differ both in their chemical structure, pharmacodynamic and pharmacokinetic properties, as well as in the possible side effects of their use. When selecting the appropriate treatment for a patient, the clinician should be guided not only by the expected therapeutic effect, but also weigh the possible side effects, especially in patients burdened with additional somatic conditions. Almost all, with the exception of pimavanserin, which is not available in Poland, of the currently registered antipsychotics are D2 receptor antagonists. Second-generation drugs additionally exert significant effects on serotonergic transmission, primarily by blocking 5HT2a receptors. On the other hand, modern third-generation antipsychotics, in addition to antagonism to D2 receptors, also exhibit partial agonism towards dopamine receptors, which allows modulation of dopaminergic transmission. The aim of this paper is to provide guidance on the selection of antipsychotics for the treatment of psychiatric patients with co-morbid somatic conditions (part I of the recommendations concerns metabolic syndrome, hyperprolactinemia and cardiovascular conditions) based on the risk of possible side effects associated with the use of antipsychotics.