Review article
Atypical antipsychotics not authorized in Poland

More than 20 atypical antipsychotics are authorized worldwide. Ten of these are authorized and available in Poland. Asenapine, registered in the treatment of manic episodes in the course of bipolar disorder, is the last atypical authorized in Poland. Moreover, several substances are being studied (in preclinical or clinical studies). Thirteen atypicals authorized outside Poland are discussed in the paper (to a degree according to their clinical significance): iloperidone, paliperidone, lurasidone, blonanserin, zotepine, perospirone, clocapramine, clotiapine, mosapramine, carpipramine, nemonapride, sultopride, remoxipride, as well as four substances being currently studied: bifeprunox, pimavanserin, vabicaserin and cariprazine. Only one, the oldest substance of this group – clozapine – maintains its special position among a vast array of atypical antipsychotic medications. Although it was discovered more than 40 years ago, we still have no other drug of comparable efficacy. Moreover, more data indicate that the traditional division of antipsychotics into first and second generation is losing its raison d’ętre – mainly due to lack of data supporting clinical superiority of the latter. However, increasing awareness of psychiatrists of the harmful effects of new antipsychotic medications (particularly in terms of metabolic complications) motivates researchers to search for safer medications. As a result, new substances combining the advantageous profile of clinical activities with a good or at least acceptable safety profile are being developed. Nevertheless, there is still a vast unmet need for more effective (particularly in treatment-refractory cases) and better tolerated antipsychotic medications.