Cardiac safety, hormonal effects and constipation
Cardiac safety
Cardiac safety is an issue because several antipsychotics have been shown to prolong ventricular repolarisation (QTc prolongation), which is associated with an increased risk of ventricular arrhythmias. Clozapine can cause myocarditis and cardiomyopathy.
Hormonal effects
Hormonal effects especially raised prolactin can lead to menstrual abnormalities, galactorrhoea and sexual dysfunction, and in the longer term reduce bone mineral density, increasing the risk of osteoporosis.
Constipation
Constipation is common but, left untreated or undetected, can lead to serious bowel obstruction. Many antipsychotics have anticholinergic effects, including constipation. Giving up smoking can also increase the risk.
Particular care should be exercised in patients receiving other drugs known to cause constipation, especially anticholinergics used to treat hypersalivation.