What is blonanserin?

Second generation antipsychotics (sometimes referred to as ‘atypical’ antipsychotics) such as blonanserin are a newer class of antipsychotic medication than first generation ‘typical’ antipsychotics. Second generation antipsychotics are effective for the positive symptoms of schizophrenia. It is sometimes claimed that they are more effective than first generation antipsychotics in treating the negative symptoms of schizophrenia. Negative symptoms include a lack of ordinary mental activities such as emotional expression, social engagement, thinking and motivation, whereas positive symptoms include the experiences of perceptual abnormalities (hallucinations) and fixed, false, irrational beliefs (delusions). Second generation antipsychotics may also cause less extra-pyramidal side effects. These include dyskinesias such as repetitive, involuntary, and purposeless body or facial movements, Parkinsonism (cogwheel muscle rigidity, pill-rolling tremor and reduced or slowed movements), akathisia (motor restlessness, especially in the legs, and resembling agitation) and dystonias such as muscle contractions causing unusual twisting of parts of the body, most often in the neck. These effects are caused by the dopamine receptor antagonist action of these drugs.

What is the evidence for blonanserin?

Compared to first generation haloperidol, moderate to high quality evidence suggests blonanserin may be more effective for negative symptoms, with a lower risk of dizziness and akathisia. Compared to second generation aripiprazole, moderate to high quality evidence finds blonanserin may be more effective for total and negative symptoms but not for positive symptoms. There were no significant differences in adverse events between blonanserin and aripiprazole or amisulpride.
Compared to second generation risperidone + paliperidone, moderate to high quality evidence finds no differences in symptoms, but blonanserin had higher risks of akathisia, agitation, and extrapyramidal disorder and lower risks of hyperprolactinemia and lower prolactin levels. Blonanserin also had a lower risk of hyperprolactinemia than risperidone + haloperidol.
October 2020
Last updated at: 4:24 am, 14th October 2020
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