Metabolic syndrome is a complex pathology characterized by imbalances in
lipid and glucose metabolism and weight gain, and consequently by an increase in the
incidence of type II diabetes and cardiovascular disease. Metabolic syndrome is rapidly
becoming one of the most important side effects of treatment with modern “atypical”
antipsychotic agents, probably due to their specific mechanisms of action. Although the
most recent members of this class (aripiprazole, asenapine, ziprasidone) seem to
produce a reduce incidence of metabolic syndrome, the problem is far from being
resolved. In this chapter, the three most important classical neuroleptics
(chlorpromazine, haloperidol and loxapine) and the most important atypical
antipsychotics will be individually analyzed in relation to their propensity to cause
metabolic syndrome. The most reliable, current data will be presented, also in the
perspective of possible interventions to mitigate metabolic imbalances, comparative
studies, switching studies and augmentation strategies. An important strategy for
metabolic syndrome prevention could also be the performing of an accurate therapeutic
drug monitoring (TDM). Thus, an up-to-date overview will also be presented of recent
and significant analytical methods for the determination of the drugs of interest and
their main metabolites in human biological fluids.
Keywords: Antipsychotic drugs, Diabetes, Hypercholesterolemia, Hypertriglyceridemia,
Metabolic syndrome (MetSyn), Obesity, Pharmacotherapy, Polypharmacy,
Therapeutic Drug Monitoring (TDM).
