Explore and compare different medications below so you and your healthcare team can decide which medication is best for you.
Amisulpride
Amisulpride carries a higher risk of hormonal side effects, especially in younger people, so it can be harder to use this medicine in adolescents and young adults. Amisulpride is sometimes used in combination with other antipsychotics such as clozapine.
Amisulpride
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Aripiprazole
Aripiprazole carries a very low risk of weight gain and hormonal side effects. Sometimes it is even used to manage these side effects caused by other antipsychotics. It can help people feel more alert, which may be a good thing, but can also make falling asleep difficult. Restlessness can also be a problem, especially in the first few weeks after starting aripiprazole but it improves with time for most people.
Aripiprazole
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Chlorpromazine
Chlorpromazine is the oldest antipsychotic. It was discovered in 1950 by accident during a search for new antihistamines (medicines for allergy). It is usually quite sedating, which can be helpful for sleep and calming effects - but not so good if this affects daily activities. It may cause dizziness and hormonal side effects.
Chlorpromazine
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Clozapine
Clozapine is very effective in treating psychosis for people who don't respond well to other antipsychotics. It is also the only antipsychotic proven to reduce the risk of self-harm. It tends to have more side effects than others including weight gain, sedation, constipation, too much saliva (spit) production and low white blood cells. Careful monitoring is needed including regular blood tests for the whole time a person takes clozapine.
Clozapine
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Flupenthixol
Flupenthixol is an older antipsychotic, only available as a long acting injection (also known as a depot) in New Zealand. It was also used as a treatment for depression back in the 70’s and 80’s. Movement side effects and hormonal side effects are common with this medicine.
Flupenthixol
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Haloperidol
Haloperidol is an older antipsychotic that is sometimes used as a short term treatment when people are distressed or agitated in hospital. It can also be used over a longer period of time as tablets, liquid or a long acting injection. Common side effects include muscle stiffness and restlessness. It doesn’t help much with motivation, focus and attention, and might actually make these worse in some people if the dose is too high.
Haloperidol
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Olanzapine
Olanzapine is often used for its calming effects when a person is distressed. It is available in tablets and a long acting injection. It seems to be slightly more effective than other antipsychotics (except clozapine). A lot of people find olanzapine makes them really hungry, which can lead to weight gain.
Olanzapine
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Paliperidone
Paliperidone is only available as a long acting monthly injection. It tends to cause less sleepiness than some of the other antipsychotics. However, movement and hormonal side effects are more common.
Paliperidone
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Pericyazine
Pericyazine is an older medicine not used very much for psychosis anymore - other medicines are usually preferred. Like all older antipsychotics, it can cause movement and hormonal side effects. Weight gain and drowsiness are also quite common.
Pericyazine
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Quetiapine
Quetiapine has some antidepressant effects, so might be good for people experiencing psychosis who also have a low mood or depression. It has a very low risk of movement and hormonal side effects, but often causes increased appetite and weight gain.
Quetiapine
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Risperidone
Risperidone is available as tablets, liquid and a fortnightly long acting injection. It tends to cause less drowsiness than some other antipsychotics but movement and hormonal side effects are more common.
Risperidone
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Ziprasidone
Ziprasidone causes less weight gain, sedation and movement and hormonal side effects than some other antipsychotics. It may even increase alertness in some people, especially at lower doses. It is more likely to cause irregular heartbeat than many other antipsychotics so a doctor or nurse may check this at the start of treatment.
Ziprasidone
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Zuclopenthixol
Zuclopenthixol is an older antipsychotic, which is available as tablets and long acting injection. It tends to be sedating and calming and can help reduce aggression and agitation. As with the other older antipsychotics, movement and hormonal side effects are quite common.
Zuclopenthixol
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Medication information was compiled from the following sources:
Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Australian & New Zealand Journal of Psychiatry. 2016;50(5):410-72.
Haddad PM, Sharma SG. Adverse effects of atypical antipsychotics : differential risk and clinical implications. CNS drugs. 2007;21(11):911-36.
Jibson MD. Second-generation antipsychotic medications: Pharmacology, administration, and side effects. 2017 [last update May 15, 2017] In: UpToDate [Internet]. [cited 2 November 2017]. Available from: https://www.uptodate.com/contents/second-generation-antipsychotic-medications-pharmacology-administration-and-side-effects
Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis.
Lancet (London, England). 2013;382(9896):951-62.
Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Salanti G, et al. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. The Lancet. 2012;379(9831):2063-71.
Marder S, Stroup T. Pharmacotherapy for schizophrenia: Side effect management. 2017 [last update Dec 01, 2016] In: UpToDate [Internet]. [cited 2 November 2017]. Available from: https://www.uptodate.com/contents/pharmacotherapy-for-schizophrenia-side-effect-management
New Zealand Formulary (NZF). NZF v[64] [Internet]. 2017. Available from: www.nzf.org.nz [accessed 02 November 2017].
Robinson DG, Gallego JA, John M, Petrides G, Hassoun Y, Zhang JP, et al. A Randomized Comparison of Aripiprazole and Risperidone for the Acute Treatment of First-Episode Schizophrenia and Related Disorders: 3-Month Outcomes. Schizophrenia bulletin. 2015;41(6):1227-36.
Stahl SM. Stahl's Essential Psychopharmacology : Neuroscientific Basis and Practical Application. 4th ed. Cambridge: Cambridge University Press 2013.
Stahl SM. Stahl's Essential Psychopharmacology: The Prescriber's Guide. 6th ed. Cambridge: Cambridge University Press 2017.
Taylor D, Paton C, Kapur S. The Maudsley prescribing guidelines in psychiatry. Twelfth edition. West Sussex, England : Wiley Blackwell. 2015.
Zhu Y, Li C, Huhn M, Rothe P, Krause M, Bighelli I, et al. How well do patients with a first episode of schizophrenia respond to antipsychotics: A systematic review and meta-analysis. European Neuropsychopharmacology. 2017;27(9):835-44.
Like any other medication, antipsychotics can cause side effects. While side effects may seem scary, they can be managed. Overall, the benefits of antipsychotics outweigh the downsides for most people.
Common side effects
Rare side effects
Medication information on this page was compiled from the following sources:
General Practitioners
A General Practitioner is a doctor you normally see when you’re physically sick, but they’re useful for dealing with mental health problems too. They might be a good starting point for if you are unwell.
Psychologists
Psychologists studied psychology at university, and they have specialised training about how people’s feelings, actions, beliefs, experiences and culture affect the way they live. They’ve learned how to listen and understand people’s emotional and psychological problems, and they’re experts at helping people reduce stress and make changes in their lives that can help them to feel better.
Psychiatrists
Psychiatrists trained as doctors first, then as specialists in diagnosing and helping people get on top of just the kind of stuff someone experiencing psychosis might be going through. They work in a range of places like hospitals, medical clinics, and community health centres. Like psychologists, they’re great at listening, understanding and offering advice. They can also prescribe medication to help with psychosis. Being a doctor, a psychiatrist will also monitor a person’s physical health and oversee their care. A person who feels they may be in crisis might see them weekly, but usually they will see them every one to three months.
Pharmacists
Pharmacists that specialise in mental health meet and talk to people with mental health issues on a regular basis. They are well placed to offer advice on medication and refer a person to other health professionals when appropriate.
Counsellors
Counsellors have training in listening, and can help people understand what’s going on and look at options they can try. Some counsellors have other training too, like social work or nursing or teaching. They might work in schools or through a community service in the local area.
Community Nurses
Community Nurses are great with linking a person experiencing psychosis and their doctor and assisting them with any physical health issues. They can help with administering and monitoring medication, including monitoring any side effects of medication the person may have.
Occupational Therapists
Occupational Therapists aim to help support people to be able to do the things they want or need to do. For example, occupational therapists might work with the person experiencing psychosis to help them with:
- setting goals and supporting them to work towards these
- developing leisure interests and roles
- self-confidence, communication and stress management
- work and study or training
- living skills including cooking, budgeting, and transport
- motivation, decision making and problem solving
- using community supports and resources
Social Workers
Social Workers have specific skills to support people around your social needs and problems in the community around e.g. education, work and income, families and relationships. They can help out with things like finding appropriate accommodation in the community to meet a person’s needs or any barriers and inequalities they may face in their daily life.
Youth Workers
Youth Workers understand what young people go through, and they're really easy to talk to. They're also connected to a bunch of other services, so if a person needs more help from a counsellor, a doctor, or a psychologist, they can get them on the right track.
General Practitioners
A General Practitioner is a doctor you normally see when you’re physically sick, but they’re useful for dealing with mental health problems too. They might be a good starting point for if you are unwell.
Psychologists
Psychologists studied psychology at university, and they have specialised training about how people’s feelings, actions, beliefs, experiences and culture affect the way they live. They’ve learned how to listen and understand people’s emotional and psychological problems, and they’re experts at helping people reduce stress and make changes in their lives that can help them to feel better.
Psychiatrists
Psychiatrists trained as doctors first, then as specialists in diagnosing and helping people get on top of just the kind of stuff someone experiencing psychosis might be going through. They work in a range of places like hospitals, medical clinics, and community health centres. Like psychologists, they’re great at listening, understanding and offering advice. They can also prescribe medication to help with psychosis. Being a doctor, a psychiatrist will also monitor a person’s physical health and oversee their care. A person who feels they may be in crisis might see them weekly, but usually they will see them every one to three months.
Pharmacists
Pharmacists that specialise in mental health meet and talk to people with mental health issues on a regular basis. They are well placed to offer advice on medication and refer a person to other health professionals when appropriate.
Counsellors
Counsellors have training in listening, and can help people understand what’s going on and look at options they can try. Some counsellors have other training too, like social work or nursing or teaching. They might work in schools or through a community service in the local area.
Community Nurses
Community Nurses are great with linking a person experiencing psychosis and their doctor and assisting them with any physical health issues. They can help with administering and monitoring medication, including monitoring any side effects of medication the person may have.
Occupational Therapists
Occupational Therapists aim to help support people to be able to do the things they want or need to do. For example, occupational therapists might work with the person experiencing psychosis to help them with:
- setting goals and supporting them to work towards these
- developing leisure interests and roles
- self-confidence, communication and stress management
- work and study or training
- living skills including cooking, budgeting, and transport
- motivation, decision making and problem solving
- using community supports and resources
Social Workers
Social Workers have specific skills to support people around your social needs and problems in the community around e.g. education, work and income, families and relationships. They can help out with things like finding appropriate accommodation in the community to meet a person’s needs or any barriers and inequalities they may face in their daily life.
Youth Workers
Youth Workers understand what young people go through, and they're really easy to talk to. They're also connected to a bunch of other services, so if a person needs more help from a counsellor, a doctor, or a psychologist, they can get them on the right track.
