Plain-language guides to the antipsychotic medications used to treat schizophrenia, sourced from FDA labeling.
Clozapine and olanzapine come from the same chemical family and share several side effects — but their indications, monitoring requirements, and place in treatment are very different.
MedicationAripiprazole is among the most weight-neutral atypical antipsychotics — but 'weight-neutral' is not the same as 'no weight gain.' Here's the honest picture.
InteractionsOf all the antipsychotic-alcohol combinations clinicians worry about, clozapine sits at the top of the list. The reasons are pharmacological, not moralistic.
TreatmentElectroconvulsive therapy is one of the oldest treatments in psychiatry and one of the most misunderstood. For specific situations in schizophrenia, the evidence is genuinely strong.
LAIAristada gives clinicians the unusual flexibility of monthly, six-week, and eight-week injections — plus a one-day initiation that skips three weeks of oral overlap. Here's how it works.
MedicationFluphenazine works — but its high D2 affinity means movement side effects (EPS, akathisia, tardive dyskinesia) are common. Here is a practical guide to recognising and managing them.
MedicationAripiprazole is the original partial dopamine agonist — neither a pure blocker nor a stimulator. The result is an antipsychotic with a distinctive side effect profile and a strong long-acting injectable presence.
MedicationPerphenazine sits in the middle of the first-generation potency spectrum and held its own against newer drugs in the CATIE trial. Here is what its side effect profile actually looks like.
MedicationAripiprazole tends to be lighter on weight gain and sedation but heavier on restlessness, sleep disruption, and a small but real risk of compulsive behaviours.
InteractionsOlanzapine plus alcohol is one of the most common antipsychotic combinations clinicians actually see. The pharmacology is less dramatic than clozapine, but it isn't trivial.
TreatmentTMS is non-invasive and FDA-cleared for several conditions, but for schizophrenia it remains experimental. The most promising signals are in persistent voices and negative symptoms.
LAIFluphenazine decanoate is one of the oldest long-acting injectables in continuous use — cheap, effective, and still a reasonable choice for the right patient.
MedicationInvega Sustenna delivers a month of paliperidone in a single intramuscular injection — designed for people who struggle with daily oral dosing and for whom adherence is a major challenge.
MedicationQuetiapine is one of the most widely used antipsychotics — heavily sedating, broadly licensed, and often prescribed off-label for sleep. The latter raises important issues.
MedicationTrifluoperazine has been around for more than 60 years. Its side effect profile is dominated by movement effects but spares the metabolism — a trade-off that still appeals to some patients.
Lab monitoringPlasma level monitoring is one of the most useful tools in clozapine prescribing. Knowing the target range, when to draw, and what affects the number turns a confusing lab into a practical guide to dosing.
InteractionsAripiprazole is often described as a 'milder' antipsychotic, which can lead to assumptions that recreational substances are safer with it. The pharmacology says otherwise.
MedicationPaliperidone is the active metabolite of risperidone. The two share most properties — but pharmacokinetics, prolactin effects, and long-acting injectable options separate them in practice.
MedicationQuetiapine is one of the most-prescribed off-label sleep aids in the United States. The reasons are understandable — and so are the concerns. Here's the honest picture.
MedicationHaloperidol is one of the oldest and most widely used antipsychotics in the world. It is potent, predictable, and affordable — but its side effect profile demands respect.
MedicationQuetiapine's most common side effects are sedation and metabolic changes. Both are predictable, both are manageable — but only with proactive monitoring and honest conversations.
LAIHaloperidol decanoate has been a workhorse LAI for decades — given monthly, inexpensive, and effective at preventing relapse. The tradeoff is a higher movement-side-effect profile.
MedicationThiothixene is a chemically distinctive but pharmacologically familiar first-generation antipsychotic. Here is what to expect from its side effect profile and how to manage it.
MedicationZiprasidone is among the most weight-neutral atypicals — but it requires food for absorption and demands attention to cardiac safety.
Drug interactionsMost antibiotics combine fine with antipsychotics — but a few common ones can sharply raise drug levels, prolong QT, or cause unique problems with clozapine.
InteractionsAntipsychotics block dopamine. Stimulants release it. Combining them is not always wrong — but it requires a clear clinical reason and careful monitoring.
TreatmentPsilocybin is being studied for depression, addiction, end-of-life distress, and more. Every major trial excludes people with personal or family history of psychosis — here's why that matters.
MedicationBrexpiprazole was designed as a less activating, less akathisia-prone cousin of aripiprazole. The pharmacology supports the idea — and the clinical evidence partly does too.
MedicationMetformin is now considered first-line pharmacological treatment for antipsychotic-induced weight gain — modest in effect size, but better-evidenced than any other option.
MedicationChlorpromazine was the first antipsychotic ever discovered and arguably the medication that emptied the asylums. It is still in use today — but its role has narrowed.