Key result
Antipsychotic use in schizophrenia is linked to ~2.7-fold higher tachycardia risk.
Why the study?
While numerous studies report an increased risk of serious adverse cardiovascular events with antipsychotic use, no prior study had evaluated the comparative risk of all antipsychotic agents in head-to-head comparisons involving randomized controlled trials.
Does the use of antipsychotic agents increase the risk of cardiovascular adverse events in adults treated for schizophrenia?
Meta-Analysis
Does the use of antipsychotic agents increase the risk of cardiovascular adverse events in adults treated for schizophrenia?
In adults treated for schizophrenia, antipsychotic use is significantly associated with an increased risk of tachycardia, though no significant risk was observed for other major cardiovascular adverse events in this meta-analysis.
May warrant heart rate monitoring with antipsychotics; extends CV safety data in schizophrenia beyond weight gain and extrapyramidal effects.
Background: Adverse drug effects of antipsychotics differ drug to drug. Older typical antipsychotic drugs are associated with greater Extra pyramidal side effects. Among the newer atypical antipsychotic drugs, weight gain has been associated with clozapine and olanzapine. There have been numerous studies reporting increased risk of serious adverse cardiovascular events associated with antipsychotics use but none study has been done evaluating comparative risk of all antipsychotic agents in head-to-head comparison involving randomized controlled trials. Methods: Systematic review was done as per PRISMA 2020 guidelines for all outcomes of all 38 studies included for a full-text review. Meta-Analysis under random-effect model for feasible 7 outcomes were possible. PubMed, Medline, DOAJ, MDPI, Clinicaltrial.gov and Google scholar article repositories were assessed for the review. RoB-2 tool was used to assess the Risk of bias and GRADE Approach was used to grade the certainty of evidence. Results: Antipsychotic agents use showed no statistically significant results with the outcomes of hypertension, serious arrythmia, myocardial infarction, bradycardia, angina, and orthostatic hypotension. Statistically significant risk was found to be associated with antipsychotic use for the outcome of Tachycardia, Risk Ratio (RR) = 2.72, 95% Confidence Interval (CI) 1.29-5.68. Conclusion: Antipsychotic use was associated with higher incidence of Tachycardia.
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Nepal et al. (2026) conducted a meta-analysis in Schizophrenia. Antipsychotic agents vs. Head-to-head comparison or control in RCTs was evaluated on Tachycardia (RR 2.72, 95% CI 1.29-5.68). Antipsychotic agent use in adults with schizophrenia was associated with a significantly higher risk of tachycardia (RR 2.72; 95% CI 1.29-5.68).
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