Types of Atypical Antipsychotic Drugs Used to Treat Schizophrenia

Common Side Effects, Indications, and Dosages

In the early 1990s, a new class of drugs was developed to treat the psychotic symptoms of schizophrenia. The drugs, called atypical antipsychotics, have generally proven as effective as earlier generation ​typical antipsychotics but with far fewer extrapyramidal side effects (including spasms, tremors, rigidity, and restlessness).

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Invega (Paliperidone)

Invega is approved to treat schizophrenia in patients over age 12 and schizoaffective disorder in adults. It is available in oral and long-acting injectable forms.

Oral Invega tablets are usually taken once per day. The dose usually ranges from 3 mg to 12 mg.

Individuals who tolerate the oral form well may begin Invega Sustenna, an injection given once a month. If you tolerate the monthly injections well, you may try Invega Trinza, an injection that is given once every three months.

Injections allow you to discontinue taking the medication orally, which can prevent you from missing doses of your medication.

Common side effects include restlessness, dizziness, headaches, fatigue, muscle weakness, weight gain, stomach pain, constipation, heartburn, and increased prolactin.

Abilify (Aripiprazole)

Abilify (aripiprazole) received market approval from the U.S. Food and Drug Administration (FDA) in 2003 for use in the treatment of schizophrenia and bipolar disorder. It is also sometimes used in the treatment of major depression, obsessive-compulsive disorder (OCD), and irritability associated with autism.

The standard adult dose is 10 to 15 milligrams per day. While as much as 30 milligrams may be prescribed daily, the dose may be lower when used to augment antidepressants (between 2 and 5 milligrams). Abilify does not have an FDA indication to treat schizophrenia in children under 13 or to treat bipolar disorder in children under 10.

Common side effects include weight gain, headache, agitation, anxiety, insomnia, nausea, constipation, and lightheadedness.

Risperdal (Risperidone)

Risperdal (risperidone) received its FDA approval in 1994 and is commonly used to treat schizophrenia, bipolar disorder, and irritability associated with autism.

A common adult dosage is between two and three milligrams per day although it can be higher, while children are typically prescribed doses more in the range of .5 milligrams daily. Risperdal is not FDA indicated to treat schizophrenia in children under 13, to treat bipolar disorder in children under 10, or to treat autism-related irritability in children under five.

Side effects include dizziness, nausea, constipation, and increases in prolactin. While it has less sedating effects than some of other atypical antipsychotics, it tends to have more extrapyramidal side effects than some of the other drugs.

Zyprexa (Olanzapine)

Zyprexa (olanzapine) was approved by the FDA in 1996 for use in the treatment of schizophrenia and bipolar disorder.

The typical adult dose is between 10 and 15 milligrams per day. The adolescent dose is lower, generally between 2.5 to 10 milligrams per day. Zyprexa does not have an FDA indication in children under the age of 13.

The main side effects of Zyprexa are weight gain and potential metabolic effects including increased blood sugar and lipid levels.

By contrast, the drug has a lower rate of motor side effects than some of the other atypical antipsychotics.​

Seroquel (Quetiapine)

Seroquel (quetiapine) received FDA approval in 1997 for use in the treatment of schizophrenia, both the manic and depressive aspects of bipolar disorder.

There is a wide dose range in the use of Seroquel. For schizophrenia, a daily dose of between 400 and 800 milligrams is not uncommon. Like some of the other atypical antipsychotics, Seroquel does not have a formal FDA indication to treat schizophrenia in children under 13 or to treat bipolar disorder in children under 10.

Seroquel has a low incidence of motor side effects. While side effects may include weight gain and high blood sugar, they are typically less profound than with Zyprexa or Clozaril. Other side effects include sedation and low blood pressure when standing.

Geodon (Ziprasidone)

Geodon (ziprasidone) received FDA approval in 2001 and is used to treat schizophrenia and either a manic or mixed episode of bipolar disorder. It is sometimes used off label to treat post-traumatic stress disorder (PTSD) and adjunctively in major depression.

The standard adult dose is between 80 and 160 milligrams per day. An intramuscular formulation is also available to treat acute agitation in schizophrenia. Geodon is not indicated for use in children under 10.

While Geodon is less likely to cause weight gain or extrapyramidal symptoms, it can cause cardiac arrhythmia (irregular heartbeat), dizziness, and a drop in blood pressure when standing.

Clozaril (Clozapine)

Clozaril (clozapine) was the first of the atypical antipsychotics to receive FDA approval in 1990 and remains a mainstay of care for persons with treatment-resistant schizophrenia. While it has also been shown to reduce suicidality, it does come with a number of significant side effects.

The standard adult dose can vary and may range somewhere between 300 and 700 milligrams per day. Checking blood levels of the drug can sometimes be helpful.

Some of the side effects of Clozaril are serious and potentially fatal. It is associated with the risk of lowering white blood cells which can result in death. Therefore, the use of Clozaril requires ongoing blood tests to detect a potential drop in these cells. Since this type of monitoring has been instituted, the incidence of medical consequences relates to this has been significantly reduced.

It is not recommended in elderly persons with dementia. Drug-related myocarditis (heart inflammation) has also been known to occur and may also be fatal.

Other side effects include weight gain, constipation, drowsiness, bed wetting, nighttime drooling, and high blood sugar. People on Clozaril require frequent follow-ups and medical oversight to monitor for the development of any side effects.

Vraylar (Cariprazine)

Vraylar is a once-a-day medication that can help manage the overall symptoms of schizophrenia and also has an indication for the acute treatment of manic or mixed episodes in bipolar disorder.

It works gradually so you aren't likely to get immediate relief from your symptoms. It's important to talk to your doctor about how you're feeling so you can know if this is the right medication for you.

The most common side effects include restlessness, insomnia, and weight gain.

In 6-week clinical studies, patients experienced an average weight gain of about 2.2 pounds, compared to those on a placebo who gained about .7 pounds.

Vaylar may also increase your blood sugar. If you have diabetes or risk factor for diabetes, your blood sugar will need to be monitored during treatment.

Saphris (Asenapine)

Saphris is approved for the treatment of schizophrenia in adults.

One clinical study showed Saphris can help lower the risk of relapse in adults whose symptoms are under control.

Common side effects associated with Saphris include sleepiness, dizziness, muscle stiffness, weight gain, numbing of the mouth, and restlessness.

Rexulti (Brexpiprazole)

Rexulti is a medication that is commonly prescribed as an adjunct for individuals with depression but it is also used to treat schizophrenia.

Like many other atypical antipsychotics, it affects the serotonin and dopamine levels in the brain.

The most common side effects of Rexulti may include restlessness, weight gain, and respiratory issues.

There have been reports of individuals taking Rexulti experiencing compulsive urges, such as gambling, binge eating, compulsive shopping, and sexual urges.

Fanapt (Iloperidone)

Fanapt is used to treat schizophrenia and off label in certain mood disorders. Like all of these atypical antipsychotics, it can help you have fewer hallucinations, delusions, think more clearly, feel less nervous, and possibly feel more motivated to participate in daily activities.

It is usually taken two times per day. A doctor will usually start you on a low dose and will gradually increase it until you are on the best dose for you. It may take 1 to 2 weeks to build up to the full dose.

Common side effects include dizziness, drowsiness, and lightheadedness. Dry mouth, stuffy nose, and weight gain may also occur.

Fanapt may cause a serious drop in blood pressure, especially when starting or increasing the dose. This may increase your risk of falling and it's important to get up slowly when rising from a sitting or lying position.

Latuda (Lurasidone)

Latuda is approved for the treatment of schizophrenia in patients 13 years of age or older as well as for bipolar depression. The dose typically ranges from 40 mg to 160 mg.

Latuda may decrease hallucinations, delusions, and improve your mood, sleep, appetite, and energy level.

Common side effects are sleepiness, restlessness, agitation, and upset stomach. Latuda should be taken with food to improve absorption.

Rare side effects may include increased prolactin levels, which can cause females to lose their period or produce breast milk and may cause males to experience erectile problems, have enlarged breast tissue, or lose their sex drive.

A Word From Verywell

All atypical antipsychotics carry a black box warning that states the medication is not approved for use in elderly patients with dementia-related psychosis due to increased risk of death.

It's important to talk to your doctor about any medications you are taking and to watch closely for possible side effects.

Despite the risks, you and your doctor may decide that an atypical antipsychotic is the best choice for managing your illness. You might find one of these medications helps you manage your symptoms well so you can function at your best.

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