Pediatr Drugs 2004; 6 (1): 33-44 REVIEW ARTICLE 1174-5878/04/0001-0033/$31.00/0  2004 Adis Data Information BV. All rights reserved. Weight Gain Associated with Atypical Antipsychotic Use in Children and Adolescents Prevalence, Clinical Relevance, and Management Kimberly A. Stigler, 1 Marc N. Potenza, 2 David J. Posey 1 and Christopher J. McDougle 1 1 Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA 2 Department of Psychiatry, Yale University School of Medicine, Newhaven, Connecticut, USA Contents Abstract ................................................................................................................ 33 1. Epidemiology ....................................................................................................... 34 2. Potential Mechanisms of Weight Gain with Atypical Antipsychotics ...................................................... 34 3. Clozapine .......................................................................................................... 35 4. Risperidone ........................................................................................................ 35 5. Olanzapine ........................................................................................................ 36 6. Quetiapine ......................................................................................................... 36 7. Ziprasidone ......................................................................................................... 37 8. Aripiprazole ........................................................................................................ 37 9. Clinical Relevance .................................................................................................. 37 9.1 Diabetes Mellitus ............................................................................................... 37 9.2 Hyperlipidemia ................................................................................................. 39 10. Monitoring and Management of Weight Gain ......................................................................... 39 11. Conclusions ........................................................................................................ 41 Atypical antipsychotics are increasingly prescribed to children and adolescents with neuropsychiatric Abstract disorders. Although their profile of potent antagonism at specific serotonin and dopamine receptors offers certain advantages compared with typical antipsychotics, their use has been associated with various adverse effects, including significant weight gain. This adverse effect is of particular concern in children and adolescents, secondary to the immediate and long-term health risks associated with weight gain, including obesity, diabetes mellitus, and hyperlipidemia. Indeed, from 1963 to 1991, the prevalence of obesity has approximately doubled in youth. Prior to selecting an atypical antipsychotic, a detailed review of the predictors of weight gain is necessary for every child and adolescent. Published data suggest that clozapine and olanzapine are associated with considerable weight gain, whereas risperidone and quetiapine have a moderate risk. Alternatively, ziprasidone and aripiprazole may exhibit a low risk for this adverse effect. Whereas behavioral and pharmacologic measures are available to manage weight gain associated with atypical antipsychotics, research is needed to establish more effective and safe interventions for this adverse effect in children and adolescents. Antipsychotics are commonly prescribed to children and ado- tagonism, were first introduced in the 1950s. Although useful for lescents for a variety of neuropsychiatric conditions. The typical reducing target symptoms of psychosis, typical antipsychotics antipsychotics, with their profile of dopamine D 2 receptor an- were found to be associated with significant adverse effects,