Increased infection rates associated with second-generation antipsychotics.

TO THE EDITOR: The use second-generation antipsychotic (SGA) medications is increasing for both FDAapproved and off-label indications. This means that more individuals are being exposed to potential adverse effects of these medications. Clinicians have frequently focused on weight gain and metabolic syndrome, tardive dyskinesia, and prolactin elevations associated with antipsychotic use. Leukopenia is a class-wide warning for all SGAs. Most clinicians associate leukopenia and neutropenia with clozapine, which requires a specific risk evaluation and mitigation strategy, but these conditions also have been observed with other antipsychotics, including risperidone, olanzapine, and quetiapine. The overriding concerns about using these medications are neutropenia and death due to infection. However, infections are common and may occur independent of neutropenia. We investigated the infection rates observed in pivotal trials of SGAs that were submitted to the FDA.