Gender differences in the prescribing of antipsychotic drugs

Am J Psychiatry. 2004 Aug;161(8):1324-33. doi: 10.1176/appi.ajp.161.8.1324.


Objective: The aim of this article is to offer recommendations and rationale for gender-specific antipsychotic treatment.

Method: The author summarizes reviews of recent literature in psychiatric clinical trials, pharmacology, drug safety, toxicology, obstetrics and gynecology, and pediatrics.

Results: The pharmacokinetics and pharmacodynamics of antipsychotic drugs differ in women and men and are influenced by gender-specific factors such as body build, diet, smoking, concurrent medication, exercise, substance use, and hormonal transitions. In general, and for some drugs in particular, women require lower doses in order to stay well. Because preliminary drug testing is not done in pregnant women, the issue of effective dosing during pregnancy is unstudied, and safety for fetuses and nursing infants may not become evident until a drug is widely used. Specific adverse effects on issues crucial to women (e.g., parenting) have not been well studied, but some side effects, such as weight gain, passivity, hypotension, and hyperprolactinemia, are reported to be particularly problematic for women. Some serious side effects are more often seen among women than among men.

Conclusions: Optimal maintenance regimens of antipsychotics for women and men are not the same.

Publication types

  • Review

MeSH terms

  • Antipsychotic Agents / adverse effects
  • Antipsychotic Agents / pharmacokinetics
  • Antipsychotic Agents / therapeutic use*
  • Breast Feeding / adverse effects
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Interactions
  • Drug Prescriptions / standards
  • Female
  • Humans
  • Lactation / metabolism
  • Male
  • Milk, Human / chemistry
  • Milk, Human / metabolism
  • Pharmacogenetics
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'* / standards
  • Pregnancy
  • Pregnancy Complications / drug therapy
  • Research Design
  • Schizophrenia / diagnosis
  • Schizophrenia / drug therapy
  • Sex Factors


  • Antipsychotic Agents