Cardiometabolic Effects of Atypical Antipsychotics and the Role of Metformin in Risk Mitigation

INTRODUCTION Atypical antipsychotics are essential in managing various psychiatric disorders but are associated with significant cardiometabolic side effects, including weight gain, insulin resistance, and dyslipidemia. These adverse effects increase the risk of metabolic syndrome and cardiovascular diseases in patients undergoing long-term antipsychotic therapy. Understanding the underlying mechanisms, such as alterations in appetite regulation, glucose, and lipid metabolism, is crucial for developing effective management strategies. OBJETIVE To analyze the cardiometabolic changes induced by atypical antipsychotics and evaluate the efficacy of metformin in mitigating these metabolic disturbances.  METHODS This is a narrative review which included studies in the MEDLINE – PubMed (National Library of Medicine, National Institutes of Health), COCHRANE, EMBASE and Google Scholar databases, using as descriptors: “Atypical antipsychotics” AND “Metabolic syndrome” OR “Insulin resistance” OR “Metformin therapy” OR “Cardiovascular risk” in the last years. RESULTS AND DISCUSSION Recent studies have investigated the use of metformin, a well-established antidiabetic medication, as an adjunct therapy to address antipsychotic-induced metabolic disturbances. Evidence suggests that metformin can attenuate weight gain, improve insulin sensitivity, and favorably modify lipid profiles in patients receiving atypical antipsychotics. Clinical trials have demonstrated that metformin is effective in both preventing and reducing these metabolic side effects, with a favorable safety and tolerability profile. CONCLUSION Incorporating metformin into the treatment regimen of patients on atypical antipsychotics may offer a viable strategy to mitigate cardiometabolic risks. However, individualized treatment plans, regular monitoring, and a multidisciplinary approach are essential to optimize patient outcomes and ensure the safe integration of metformin therapy in psychiatric care.