Which of the following has the lowest risk for sexual dysfunction and weight gain?

A. Clozapine (Clozaril) is a second-generation (atypical) antipsychotic with a high risk of weight gain, metabolic syndrome, and sedation due to its strong antagonism of histamine (H1) and serotonin (5-HT2C) receptors. It can also cause sexual dysfunction due to its impact on dopamine and prolactin levels.

B. Olanzapine (Zyprexa) has a significant risk of weight gain and metabolic side effects, similar to clozapine. It is known to cause hyperlipidemia, insulin resistance, and increased appetite, contributing to obesity. Sexual dysfunction can occur but is less common than with prolactin-elevating antipsychotics.

C. Haloperidol (Haldol) is a first-generation (typical) antipsychotic with a high risk of sexual dysfunction due to prolactin elevation from strong dopamine (D2) receptor blockade. While it has a lower risk of weight gain than atypical antipsychotics, it carries a high risk of extrapyramidal symptoms (EPS).

D. Aripiprazole (Abilify) is a partial dopamine agonist and has the lowest risk of weight gain among atypical antipsychotics. It also has a minimal impact on prolactin levels, reducing the risk of sexual dysfunction. Due to its unique mechanism, it is often preferred for patients concerned about metabolic side effects and sexual health.

A. Clozapine (Clozaril) does not require food for absorption, but it has a high risk of sedation, weight gain, and metabolic side effects. It also requires regular blood monitoring due to the risk of agranulocytosis.

B. Aripiprazole (Abilify) can be taken with or without food, as food does not significantly affect its absorption. It is a partial dopamine agonist, associated with a lower risk of weight gain and metabolic issues compared to other atypical antipsychotics.

C. Lurasidone (Latuda) must be taken with at least 350 calories of food to ensure proper absorption. Taking it on an empty stomach reduces its bioavailability, making it less effective. It is considered a weight-neutral antipsychotic and has a lower risk of metabolic side effects.

D. Haloperidol (Haldol) does not require food for absorption. It is a first-generation antipsychotic (FGA) with a high risk of extrapyramidal symptoms (EPS) but minimal metabolic effects.