The aim of this paper was to review the current literature on pharmacological treatments for metabolic complications induced by second-generation antipsychotics in patients with schizophrenia and to compare their efficacy. Data from meta-analyses, randomized studies, cohort studies and systematic reviews were analysed, focusing on the use of metformin, topiramate, GLP-1 agonists, SGLT2 inhibitors, opioid receptor antagonists, bupropion, and aripiprazole. The largest body of evidence for efficacy was found for metformin, especially in patients after the first episode of the disease. Topiramate and bupropion also cause weight loss, although their use may be associated with some adverse effects. GLP-1 agonists have a beneficial effect on body weight and metabolic parameters, but require continuous therapy. SGLT2 inhibitors and aripiprazole improve the metabolic profile, but clinical data remain limited. Samidorfan is effective only in combination with olanzapine. Pharmacological strategies to reduce metabolic complications due to second-generation antipsychotics are promising but require further long-term studies and evaluation of combination therapy. Personalized treatment and close patient monitoring remain crucial to improve the safety and efficacy of antipsychotic therapy.