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Antipsychotics for Treating Schizophrenia

Examples

First-generation, or typical, antipsychotic medicine

Generic Name Brand Name
chlorpromazine  
fluphenazine Prolixin
haloperidol Haldol
perphenazine  
thioridazine  
trifluoperazine Stelazine

Second-generation, or atypical, antipsychotic medicines

Generic Name Brand Name
aripiprazole Abilify
clozapine Clozaril
olanzapine Zyprexa
paliperidone Invega
quetiapine Seroquel
risperidone Risperdal, Risperdal Consta
ziprasidone Geodon

These medicines are available in liquid, tablet, or injectable form.

How It Works

Experts don't know exactly how these antipsychotic medicines work. They think these medicines work because of how they affect brain chemicals (neurotransmitters). They usually are started at low doses to avoid side effects.

Why It Is Used

Antipsychotics are used to reduce anxiety and agitation that often happen in schizophrenia. They can also reduce problems with thinking or remembering (cognitive impairment) and reduce or control delusions and hallucinations (psychosis).

Clozapine has been shown to help people who may be thinking about suicide. The U.S. Food and Drug Administration (FDA) approved clozapine for treating suicidal behavior associated with schizophrenia or for treating severe schizophrenia that has not improved with other medicines. Its use for treating other symptoms of schizophrenia has not yet been approved in the U.S., except through special authorization. When you use this medicine, your name goes into the Clozaril National Registry so that if you have severe side effects, you are not given the medicine again.

How Well It Works

For some people, these medicines may reduce or eliminate many symptoms of schizophrenia. Other people may have to try other antipsychotic medicines to find the one that works best for them.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.

Neuroleptic malignant syndrome (NMS) is an extremely rare but serious side effect that has been reported by people who take antipsychotic medicines. NMS causes life-threatening problems with your body's ability to regulate its temperatures.

Call 911 or other emergency services right away if you have a fever and:

  • Muscle rigidity.
  • Fast or irregular heartbeat.
  • Rapid breathing.
  • Severe sweating.

Other side effects of antipsychotic medicines include:

Managing side effects

It may take several attempts to find the right dose and medicine to treat your symptoms. Effectiveness and side effects for each medicine vary from person to person.

Some side effects are minor. You can manage these through lifestyle changes such as exercise, relaxation techniques, and diet changes. Other side effects can be more serious and require changes to the dose or type of medicine.

Clozapine may cause a rare but possibly life-threatening side effect called agranulocytosis, a problem that causes your body to make fewer white blood cells. Weekly blood cell tests are taken during the first 6 months of treatment with this medicine, every 2 weeks during the next 6 months of treatment, then monthly while on this medicine. This helps the doctor find this side effect early.

Talk to your doctor or pharmacist about drinking grapefruit juice while taking an antipsychotic medicine. Grapefruit juice can increase the level of these medicines in your blood. Having too much medicine in your blood increases the chances of having serious side effects.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Before you take an antipsychotic medicine, be sure to tell your doctor if you have:

  • A heart condition.
  • A seizure disorder.
  • Problems with liver function.
  • Problems with blood pressure.
  • Diabetes or high blood sugar.
  • Constipation.
  • A history of breast cancer.
  • Problems with swallowing.
  • Problems with fainting.

These medicines should be started in low doses. Talk with your doctor about any other medicines you may be taking to make sure there are no negative drug interactions. Avoid herbal stimulants (such as ma huang, ginseng, or kola) while taking an antipsychotic medicine.

You may need regular liver tests, blood tests, and blood pressure monitoring while you are taking an antipsychotic medicine. Your doctor may also monitor your weight and blood sugar.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Women who use this medicine during pregnancy have a slightly higher chance of having a baby with birth defects. If you are pregnant or planning to get pregnant, you and your doctor must weigh the risks of using this medicine against the risks of not treating your condition.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Lisa S. Weinstock, MD - Psychiatry
Last Revised August 31, 2012

Last Revised: August 31, 2012

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