Antipsychotic Agents | ||||
| NAME | USUAL PO DAILY DOSE, mg | SIDE EFFECTS | SEDATION | COMMENTS |
|---|---|---|---|---|
| First-generation antipsychotics | ||||
| Low potency | ||||
Chlorpromazine (Thorazine) Thioridazine (Mellaril) | 100-1000 100-600 | Anticholinergic effects; orthostasis; photosensitivity; cholestasis; QT prolongation | +++ | EPSEs usually not prominent; can cause anticholinergic delirium in elderly pts |
| Midpotency | ||||
| Trifluoperazine (Stelazine) | 2-50 | Fewer anticholinergic side effects | ++ | Well tolerated by most pts |
| Perphenazine (Trilafon) | 4-64 | Fewer EPSEs than with higher potency agents | ++ | |
| Loxapine (Loxitane) | 30-100 | Frequent EPSEs | ++ | |
| Molindone (Moban) | 30-100 | Frequent EPSEs | 0 | Little weight gain |
| High potency | ||||
| Haloperidol (Haldol) | 5-20 | No anticholinergic side effects; EPSEs often prominent | 0/+ | Often prescribed in doses that are too high; long-acting injectable forms of haloperidol and fluphenazine available |
| Fluphenazine (Prolixin) | 1-20 | Frequent EPSEs | 0/+ | |
| Thiothixene (Navane) | 2-50 | Frequent EPSEs | 0/+ | |
| Second-generation antipsychotics | ||||
| Clozapine (Clozaril) | 150-600 | Agranulocytosis (1%); weight gain; seizures; drooling; hyperthermia | + + | Requires weekly WBC count for first 6 months, then biweekly if stable |
| Risperidone (Risperdal) | 2-8 | Orthostasis | + | Requires slow titration; EPSEs observed with doses >6 mg qd |
| Olanzapine (Zyprexa) | 10-30 | Weight gain | ++ | Mild prolactin elevation |
| Quetiapine (Seroquel) | 350-800 | Sedation; weight gain; anxiety | +++ | Bid dosing |
| Ziprasidone (Geodon) | 120-200 | Orthostatic hypotension | +/++ | Minimal weight gain; increases QT interval |
| Aripiprazole (Abilify) | 10-30 | Nausea, anxiety, insomnia | 0/+ | Mixed agonist/antagonist; ER available |
| Paliperidone (Invega) | 3-12 | Restlessness, EPSEs, increased prolactin, headache | + | Active metabolite of risperidone |
| Iloperidone (Fanapt) | 12-24 | Dizziness, hypotension | 0/+ | Requires dose titration; long-acting injectable available |
| Asenapine (Saphris) | 10-20 | Dizziness, anxiety, EPSEs, minimal weight gain | ++ | Sublingual tablets; bid dosing |
| Lurasidone (Latuda) | 40-80 | Nausea, EPSEs | ++ | Uses CYP3A4 |
| Brexpiprazole (Rexulti) | 1-4 | Anxiety, dizziness, fatigue | ++ | CYP3A4 and 2D6 interactions |
| Pimavanserin (Nuplazid) | 34 | Edema, confusion, sedation | ++ | Approved for Parkinson's disease psychosis |
| Cariprazine (Vraylar) | 1.5-6 | EPSEs, vomiting | ++ | Preferential D3 receptor affinity |