Antipsychotic Medications

First-generation antipsychotic medications

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 adults and in people with impaired balance or serious medical disorders.

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 medications

Aripiprazole*Aripiprazole*

AsenapineAsenapine

BrexpiprazoleBrexpiprazole

CariprazineCariprazine

ClozapineClozapine

IloperidoneIloperidone

LumateperoneLumateperone

LurasidoneLurasidone

Olanzapine*Olanzapine*

Paliperidone*Paliperidone*

PimavanserinPimavanserin

QuetiapineQuetiapine

Risperidone*Risperidone*

ZiprasidoneZiprasidone

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

Some of these medications 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 medications 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)

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

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 medications.

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 effect

Muscarinic receptor agonists

Xanomeline-TrospiumXanomeline-Trospium

Gastrointestinal side effects (nausea, vomiting, constipation) and anticholinergic side effects (such as blurred vision) can be seen.