Antipsychotic Drugs

First-generation antipsychotic drugs

ChlorpromazineChlorpromazine

Fluphenazine*Fluphenazine*

Haloperidol*Haloperidol*

LoxapineLoxapine

MolindoneMolindone

PerphenazinePerphenazine

PimozidePimozide

ThioridazineThioridazine

ThiothixeneThiothixene

TrifluoperazineTrifluoperazine

Dry mouth

Blurred vision

Seizures

Increased heart rate and decreased blood pressure

Constipation

Sudden but often reversible tremor and muscle stiffness that may progress to rigidity

Involuntary movements of the face and arms (tardive dyskinesia)

Muscle rigidity, fever, high blood pressure, and changes in mental function (neuroleptic malignant syndrome)

Side effects are much more likely in older people and in people with impaired balance or serious medical disorders.

Long-acting injectable forms of haloperidol and fluphenazine are available.Long-acting injectable forms of haloperidol and fluphenazine are available.

Eye examination and electrocardiography (ECG) are recommended while people are taking thioridazine.Eye examination and electrocardiography (ECG) are recommended while people are taking thioridazine.

Second-generation antipsychotic drugs

Aripiprazole*Aripiprazole*

AsenapineAsenapine

BrexpiprazoleBrexpiprazole

CariprazineCariprazine

ClozapineClozapine

IloperidoneIloperidone

LumateperoneLumateperone

LurasidoneLurasidone

Olanzapine*Olanzapine*

PaliperidonePaliperidone

QuetiapineQuetiapine

Risperidone*Risperidone*

ZiprasidoneZiprasidone

Drowsiness and weight gain (most common), which can be substantial

Some of these drugs increase risk of accumulation of fat in the abdomen, abnormal cholesterol levels in the blood, high blood pressure, and resistance to the effects of insulin (Some of these drugs increase risk of accumulation of fat in the abdomen, abnormal cholesterol levels in the blood, high blood pressure, and resistance to the effects of insulin (metabolic syndrome)

Newer antipsychotic drugs are less likely to cause tremor, muscle stiffness, involuntary movements (including tardive dyskinesia), and neuroleptic malignant syndrome, but other side effects may occur.

A long-acting injectable form is available for aripiprazole, olanzapine, and risperidone.A long-acting injectable form is available for aripiprazole, olanzapine, and risperidone.

ClozapineClozapine is used much less often because it can cause bone marrow suppression, a reduced white blood cell count, and seizures. However, it is often effective in people who are not responsive to other antipsychotic drugs.

ClozapineClozapine and olanzapineolanzapine are most likely to cause weight gain, and aripiprazolearipiprazole is the least likely.

ZiprasidoneZiprasidone does not cause weight gain but may lead to abnormalities on an electrocardiogram.

AripiprazoleAripiprazole, brexpiprazolebrexpiprazole, cariprazinecariprazine, and ziprasidoneziprasidone are less likely to cause metabolic syndrome.

LumateperoneLumateperone has a lower risk of motor and metabolic side effects, but it is contraindicated in older people with dementia-related psychosis.