Which pair has the greatest metabolic risk?

• A. Clozapine and Olanzapine
• B. Quetiapine and Risperidone
• C. Ziprasidone and Aripiprazole
• D. Lurasidone and Paliperidone

Answer: (C)

Metabolic risk in antipsychotics refers to weight gain, lipid changes, and impaired glucose metabolism that can lead to metabolic syndrome. Among these drugs, olanzapine and clozapine are the ones most strongly linked to these effects; they commonly cause substantial weight gain and unfavorable changes in lipids and blood sugar, more than other atypical antipsychotics. Because of that, a pair including olanzapine and clozapine carries the greatest metabolic burden. In contrast, agents like ziprasidone and aripiprazole tend to have lower metabolic impact, while quetiapine and risperidone have moderate risk, and lurasidone and paliperidone fall in between. The key point is that the drugs with the strongest association with metabolic syndrome are olanzapine and clozapine, driving the highest overall metabolic risk.