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:
How long will medication take to work?
Antipsychotics can help a person experiencing psychosis feel a lot better. But it’s important to remember that they’re not miracle cures - they may take some time to work. A person may feel calmer right from the first dose but the full effects may take longer.
In general, people usually notice some difference within 2 weeks of starting antipsychotics. The good effects of medication then keep building over the next couple of months. Sometimes, people continue to improve over many months or years if they keep taking medication.
How long do people need to take medication for?
This depends on the person and should be discussed with the care team.
Most experts recommend taking an antipsychotic for at least 1-2 years after a first episode of psychosis before deciding whether to come off it slowly or continue.
Some people may need to keep taking antipsychotics to stay well. This is because antipsychotics can prevent the signs of psychosis returning. People who relapse after stopping medication are often advised by their care team to continue taking medication indefinitely. This can seem overwhelming, but it is important to remember that the biggest priority is staying well and leading a good life. Medicines can be a part of this.
Whatever the person and their team decide, it is important not to stop medication suddenly, as this can cause the signs of psychosis to return suddenly (clinicians often refer to this as 'rebound psychosis'). Slowly reducing the dose of medication increases the chance of remaining well.
Do people need any tests while taking antipsychotics?
Care teams are good at making sure people taking antipsychotics have their health checked regularly. The tests needed, and how often they are needed depends on which medication the person takes and whether they are experiencing side effects. In general, tests are usually needed before starting any medication, then repeated in the first three or four months after starting. Then they are normally done every year, or more often if the doctor advises it.
Tests may include blood tests, measuring weight, blood pressure and heart function.
Blood tests often look at:
- The number of white blood cells- this is used to check how well the immune system is working to protect against infections
- How well the kidneys and liver are working
- How much cholesterol (lipids or fat) is in the blood
- Blood sugar control and risk of diabetes
Weight and blood pressure are usually measured before starting medication, then every few weeks for the first few months. Some medicines can cause weight gain and/or affect blood pressure so it is important to check these regularly after starting or changing medication. The care team may also want to check the heart by doing an electrocardiogram (ECG). This short, pain-free test involves placing several sensors on the arms, legs and chest to trace heart activity. An ECG can be used to check your risk of an irregular heart beat and make sure the heart is pumping properly.
Taking antipsychotics with other medications
Antipsychotics can interfere or interact with other medication. Other medication may also interfere with antipsychotics.
Before starting any new medication it is always best to check with the pharmacist or doctor if they can be taken together. This also applies to medication, vitamins, and herbal products bought from pharmacies, supermarkets and health food shops. It helps if the person only goes to one pharmacy - that way the pharmacy will have a record of all their usual medication which makes it easy to check for interactions.
Taking antipsychotics with…
Smoking cigarettes can change the blood levels of some antipsychotic medication (in particular clozapine and olanzapine). If someone taking an antipsychotic starts or stops smoking, or even changes how many cigarettes they smoke, they should discuss this with their doctor in advance, as their dose of medication might need to be changed.
Quitline can help people to quit smoking.
Too much caffeine (coffee, tea, energy drinks) can cause anxiety, agitation and restlessness. This might reduce some of the helpful effects of medication. It may also increase the levels of some antipsychotics (such as clozapine).
Many antipsychotics can interfere with being alert, concentration and driving performance.
Antipsychotics can make people feel sleepy and drowsy, or affect coordination and reaction time. This is usually more of a problem when starting a new medication or increasing the dose. It is important to stop driving during this time if the person experiences any of these side effects. Drowsiness usually gets better over time once the body has adjusted to a new medication or a change in dose. People who are worried about this should talk to their care team.
Drinking alcohol, smoking marijuana or synthetic cannabis or taking other drugs can make psychosis worse for many people. It’s often best to avoid drugs and alcohol altogether. Drugs and alcohol can also reduce the effect of antipsychotics and add to side effects such as drowsiness and poor coordination, which can lead to falls or accidents.
Once people get used to their medication they may be able to drink some alcohol without it causing any problems. It still pays to limit the amount of alcohol to one or two drinks. We know that many people will continue to drink alcohol or use drugs while taking medication. It’s important not to stop medication even if this is the case.
Community Alcohol and Drug Services (CADS) can offer advice on safer use of drugs for people who take medication
The safety of most medication during pregnancy including antipsychotics is not fully known as medication is not usually tested in pregnant women.
It is reassuring that antipsychotics have not been associated with birth defects if they are taken during pregnancy. However, they have been linked to other risks such as the baby being born earlier than usual, the baby having higher or lower weight at birth, or the baby having withdrawal symptoms after birth including crying more often, irritability, and feeding problems.
Different medicines have varying levels of safety in pregnancy. If a woman taking antipsychotics is planning to become pregnant they should discuss this with the care team in advance. If a woman discovers she is already pregnant it is important to contact the care team as soon as possible. Stopping medication can increase the risk of psychosis coming back or getting worse. Untreated psychosis also carries risks for both mother and baby and can affect the mother-baby relationship when the baby is born. The care team can help women and their families weigh up the risks and benefits of medication in pregnancy.
The safety of most medication during breastfeeding including antipsychotics is not fully known as medication is not usually tested in breastfeeding women. It really depends on how much information we have on the particular medication and how much of it actually passes into breast milk. Most of the time women who take antipsychotic medication can still breastfeed, but sometimes extra precautions may be needed.
It is important to fully discuss the risks and benefits of taking medication while breastfeeding with the care team in advance.
How long will medication take to work?
Antipsychotics can help a person experiencing psychosis feel a lot better. But it’s important to remember that they’re not miracle cures - they may take some time to work. A person may feel calmer right from the first dose but the full effects may take longer.
In general, people usually notice some difference within 2 weeks of starting antipsychotics. The good effects of medication then keep building over the next couple of months. Sometimes, people continue to improve over many months or years if they keep taking medication.
How long do people need to take medication for?
This depends on the person and should be discussed with the care team.
Most experts recommend taking an antipsychotic for at least 1-2 years after a first episode of psychosis before deciding whether to come off it slowly or continue.
Some people may need to keep taking antipsychotics to stay well. This is because antipsychotics can prevent the signs of psychosis returning. People who relapse after stopping medication are often advised by their care team to continue taking medication indefinitely. This can seem overwhelming, but it is important to remember that the biggest priority is staying well and leading a good life. Medicines can be a part of this.
Whatever the person and their team decide, it is important not to stop medication suddenly, as this can cause the signs of psychosis to return suddenly (clinicians often refer to this as 'rebound psychosis'). Slowly reducing the dose of medication increases the chance of remaining well.
Do people need any tests while taking antipsychotics?
Care teams are good at making sure people taking antipsychotics have their health checked regularly. The tests needed, and how often they are needed depends on which medication the person takes and whether they are experiencing side effects. In general, tests are usually needed before starting any medication, then repeated in the first three or four months after starting. Then they are normally done every year, or more often if the doctor advises it.
Tests may include blood tests, measuring weight, blood pressure and heart function.
Blood tests often look at:
- The number of white blood cells- this is used to check how well the immune system is working to protect against infections
- How well the kidneys and liver are working
- How much cholesterol (lipids or fat) is in the blood
- Blood sugar control and risk of diabetes
Weight and blood pressure are usually measured before starting medication, then every few weeks for the first few months. Some medicines can cause weight gain and/or affect blood pressure so it is important to check these regularly after starting or changing medication. The care team may also want to check the heart by doing an electrocardiogram (ECG). This short, pain-free test involves placing several sensors on the arms, legs and chest to trace heart activity. An ECG can be used to check your risk of an irregular heart beat and make sure the heart is pumping properly.
Taking antipsychotics with other medications
Antipsychotics can interfere or interact with other medication. Other medication may also interfere with antipsychotics.
Before starting any new medication it is always best to check with the pharmacist or doctor if they can be taken together. This also applies to medication, vitamins, and herbal products bought from pharmacies, supermarkets and health food shops. It helps if the person only goes to one pharmacy - that way the pharmacy will have a record of all their usual medication which makes it easy to check for interactions.
Taking antipsychotics with…
What other people find helpful
What is an electrocardiogram?
Smoking cigarettes can change the blood levels of some antipsychotic medication (in particular clozapine and olanzapine). If someone taking an antipsychotic starts or stops smoking, or even changes how many cigarettes they smoke, they should discuss this with their doctor in advance, as their dose of medication might need to be changed.
Quitline can help people to quit smoking.
Too much caffeine (coffee, tea, energy drinks) can cause anxiety, agitation and restlessness. This might reduce some of the helpful effects of medication. It may also increase the levels of some antipsychotics (such as clozapine).
Many antipsychotics can interfere with being alert, concentration and driving performance.
Antipsychotics can make people feel sleepy and drowsy, or affect coordination and reaction time. This is usually more of a problem when starting a new medication or increasing the dose. It is important to stop driving during this time if the person experiences any of these side effects. Drowsiness usually gets better over time once the body has adjusted to a new medication or a change in dose. People who are worried about this should talk to their care team.
Drinking alcohol, smoking marijuana or synthetic cannabis or taking other drugs can make psychosis worse for many people. It’s often best to avoid drugs and alcohol altogether. Drugs and alcohol can also reduce the effect of antipsychotics and add to side effects such as drowsiness and poor coordination, which can lead to falls or accidents.
Once people get used to their medication they may be able to drink some alcohol without it causing any problems. It still pays to limit the amount of alcohol to one or two drinks. We know that many people will continue to drink alcohol or use drugs while taking medication. It’s important not to stop medication even if this is the case.
Community Alcohol and Drug Services (CADS) can offer advice on safer use of drugs for people who take medication
The safety of most medication during pregnancy including antipsychotics is not fully known as medication is not usually tested in pregnant women.
It is reassuring that antipsychotics have not been associated with birth defects if they are taken during pregnancy. However, they have been linked to other risks such as the baby being born earlier than usual, the baby having higher or lower weight at birth, or the baby having withdrawal symptoms after birth including crying more often, irritability, and feeding problems.
Different medicines have varying levels of safety in pregnancy. If a woman taking antipsychotics is planning to become pregnant they should discuss this with the care team in advance. If a woman discovers she is already pregnant it is important to contact the care team as soon as possible. Stopping medication can increase the risk of psychosis coming back or getting worse. Untreated psychosis also carries risks for both mother and baby and can affect the mother-baby relationship when the baby is born. The care team can help women and their families weigh up the risks and benefits of medication in pregnancy.
The safety of most medication during breastfeeding including antipsychotics is not fully known as medication is not usually tested in breastfeeding women. It really depends on how much information we have on the particular medication and how much of it actually passes into breast milk. Most of the time women who take antipsychotic medication can still breastfeed, but sometimes extra precautions may be needed.
It is important to fully discuss the risks and benefits of taking medication while breastfeeding with the care team in advance.
