Second-generation antipsychotics: A review of recently approved agents and drugs in the pipeline

Second-generation antipsychotics are the mainstay of treatment in schizophrenia. All of these agents, with the exception of aripiprazole, have the same basic mechanism of action. However, an additional range of binding activity at other receptor sites may account for the differences in adverse effects seen between each medication in this drug class. Iloperidone, lurasidone, and asenapine are the most recently approved second-generation antipsychotics in the United States. All 3 agents have been shown to be safe and effective in the treatment of acute schizophrenia, and asenapine has also been shown to be effective for the acute treatment of mixed or manic episodes of bipolar disorder, when compared to placebo. Several compounds are also in the research pipeline that may be approved in the future for the management of schizophrenia. Researchers have identified different pharmacologic targets for these agents, which may lead to improving treatment outcomes. (Formulary. 2012;47:106-112, 119-121.)