Which second-generation antipsychotic is associated with the fewest extrapyramidal side effects?

Quetiapine (Seroquel) is recognized for having a lower incidence of extrapyramidal side effects (EPS) compared to many other antipsychotics. Extrapyramidal side effects are drug-induced movement disorders, often seen with first-generation antipsychotics and some second-generation antipsychotics. Quetiapine’s efficacy in treating symptoms of schizophrenia and bipolar disorder comes with a pharmacological profile that, particularly at lower doses, is less likely to provoke these movement abnormalities.

This characteristic is largely attributed to quetiapine's relatively lower affinity for dopamine D2 receptors compared to other antipsychotics, which is a contributing factor to the observable reduction in EPS. Instead, quetiapine has a more significant effect on serotonin receptors, which helps mitigate negative symptoms without inducing significant motoric side effects.

Other second-generation antipsychotics mentioned have been associated with higher EPS rates. For example, risperidone (Risperdal) shows a greater tendency to produce EPS, particularly at higher doses. Olanzapine (Zyprexa) and clozapine (Clozaril), while also exhibiting lower EPS compared to first-generation drugs, do not demonstrate the same level of safety regarding this