Why are SGAs often preferred over FGAs when prescribing medications for schizophrenia?

The preference for second-generation antipsychotics (SGAs) over first-generation antipsychotics (FGAs) in the treatment of schizophrenia is primarily due to their profile of side effects. SGAs typically have fewer extrapyramidal symptoms (EPS), which include movement disorders such as tremors, rigidity, and tardive dyskinesia that are more frequently associated with FGAs. This difference in side effect profiles leads to better tolerability for patients on SGAs, which can result in higher rates of adherence to the medication regimen.

Additionally, SGAs have a lower propensity to elevate prolactin levels, which can lead to unwanted side effects such as sexual dysfunction and gynecomastia. The lower incidence of these side effects is particularly important in managing the long-term treatment of schizophrenia, where maintaining patient compliance is crucial for effective management of the disorder.

While cost considerations and FDA approvals for various indications are important factors in medication choice, the primary reason SGAs are often preferred in clinical practice is their more favorable side effect profile compared to FGAs, specifically with regard to EPS and prolactin-related effects. Consequently, this leads to improved quality of life and better outcomes for patients.