Since their introduction, the use of second generation antipsychotics (SGAs) has extended far beyond schizophrenia. With the increased usage of these agents, particular attention has been paid to their metabolic and cardiac side effects. This narrative review is an attempt to briefly summarize the conclusions from recently published systematic reviews on cardio-metabolic side effects of SGAs. Although no SGA is entirely free of these adverse effects, there are major differences in their prevalence between the specific medications. Numerous studies demonstrated particularly unfavorable side effect profiles of olanzapine and clozapine. The lack of conclusive data is a major limitation for many studies, particularly in the pediatric population. In this article we also discussed the meanings of these findings, suggested cardio-metabolic screening during SGA treatment and side effect management strategies.