List of antipsychotic drugs
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Comprehensive List of Antipsychotic Drugs
Antipsychotic drugs are essential in the treatment of schizophrenia and other psychotic disorders. They are broadly categorized into first-generation (typical) and second-generation (atypical) antipsychotics. This article provides a detailed list of these drugs, highlighting their efficacy, side effects, and clinical applications.
First-Generation Antipsychotics (Typical Antipsychotics)
First-generation antipsychotics are known for their dopamine D2 receptor antagonism, which helps alleviate positive symptoms of schizophrenia but often leads to extrapyramidal side effects.
Common First-Generation Antipsychotics
- Haloperidol: Effective for acute schizophrenia but associated with significant extrapyramidal side effects 24.
- Perphenazine: Comparable in efficacy to some second-generation antipsychotics but with a higher risk of extrapyramidal symptoms 1.
- Chlorpromazine: Effective but associated with sedation and weight gain 2.
Second-Generation Antipsychotics (Atypical Antipsychotics)
Second-generation antipsychotics are preferred due to their lower risk of extrapyramidal side effects and broader efficacy, including some impact on negative symptoms and cognitive deficits.
Common Second-Generation Antipsychotics
- Clozapine: The most effective for treatment-resistant schizophrenia but associated with agranulocytosis and metabolic side effects 245.
- Olanzapine: Effective but linked to significant weight gain and metabolic issues 124.
- Risperidone: Effective with a moderate side effect profile, including prolactin elevation 124.
- Quetiapine: Effective with a lower risk of extrapyramidal symptoms but associated with sedation and weight gain 124.
- Ziprasidone: Effective with a lower risk of weight gain but associated with QTc prolongation 124.
- Aripiprazole: Partial D2 agonist with a favorable side effect profile, including lower risks of weight gain and prolactin elevation 249.
- Amisulpride: Effective, particularly for positive symptoms, with a lower risk of weight gain but potential for prolactin elevation 234.
- Paliperidone: Similar to risperidone with a risk of prolactin elevation and weight gain 2.
- Lurasidone: Effective with a lower risk of metabolic side effects but potential for sedation 2.
- Asenapine: Effective with a moderate side effect profile, including sedation 2.
- Iloperidone: Effective with a lower risk of extrapyramidal symptoms but potential for QTc prolongation 2.
Efficacy and Side Effects
Efficacy
All antipsychotic drugs are more effective than placebo in treating schizophrenia. Clozapine, amisulpride, olanzapine, and risperidone show higher efficacy compared to other antipsychotics 24.
Side Effects
- Weight Gain and Metabolic Effects: Olanzapine and clozapine are associated with significant weight gain and metabolic disturbances 124.
- Extrapyramidal Symptoms: First-generation antipsychotics and risperidone have a higher risk of causing extrapyramidal symptoms 124.
- Prolactin Elevation: Risperidone and paliperidone are notable for causing prolactin elevation 24.
- QTc Prolongation: Ziprasidone and iloperidone are associated with QTc prolongation 24.
Conclusion
Antipsychotic drugs are diverse in their efficacy and side effect profiles. First-generation antipsychotics are effective but often cause extrapyramidal side effects. Second-generation antipsychotics are generally preferred due to their broader efficacy and lower risk of certain side effects, though they come with their own risks, such as metabolic disturbances. Clinicians must tailor antipsychotic treatment to individual patient needs, balancing efficacy and side effects to optimize outcomes.
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Most relevant research papers on this topic
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1
Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.
Olanzapine is the most effective antipsychotic drug in terms of discontinuation rates, but conventional perphenazine appears similar to quetiapine, risperidone, and ziprasidone, with olanzapine associated with greater weight gain and metabolic effects.
RCTLarge Human TrialHighly Cited
2005·
5289citations
·J. Liebermanet al.The New England journal of medicine
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2
Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis
All 15 antipsychotic drugs are significantly more effective than placebo in treating acute schizophrenia, with clozapine being the most effective and least toxic.
Meta-AnalysisHighly Cited
2013·
2086citations
·S. Leuchtet al.The Lancet
3
3
Antipsychotic drugs for the acute treatment of patients with a first episode of schizophrenia: a systematic review with pairwise and network meta-analyses.
Haloperidol is the most effective antipsychotic for treating first-episode schizophrenia, but second-generation drugs show better symptom reduction and lower discontinuation rates.
Meta-AnalysisRigorous JournalHighly Cited
2017·
111citations
·Yikang Zhuet al.The lancet. Psychiatry
4
4
Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis
Second-generation antipsychotic drugs differ in efficacy, side-effects, and cost, making them a heterogeneous class for individualized treatment in schizophrenia patients.
Meta-AnalysisRigorous JournalHighly Cited
2009·
1790citations
·S. Leuchtet al.The Lancet
5
5
Antipsychotic medication in schizophrenia: a review.
Antipsychotic medications are effective in treating schizophrenia, but response and tolerability vary, with clozapine being the only effective medication for treatment-resistant schizophrenia.
Literature ReviewHighly Cited
2015·
421citations
·J. Lallyet al.British medical bulletin
6
6
Randomised controlled trials of conventional antipsychotic versus new atypical drugs, and new atypical drugs versus clozapine, in people with schizophrenia responding poorly to, or intolerant of, current drug treatment.
New atypical antipsychotic drugs show promise in improving quality of life and reducing symptoms for people with schizophrenia compared to older, inexpensive conventional drugs.
RCTLarge Human TrialHighly Cited
2006·
224citations
·S. Lewiset al.Health technology assessment
7
7
Comorbidities and the right dose: antipsychotics
Individualizing antipsychotic doses based on comorbidities, such as renal and hepatic impairment, is crucial for effective treatment of psychotic and affective disorders.
Systematic Review
2022·
3citations
·N. Simonet al.Expert Opinion on Drug Metabolism & Toxicology
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8
An update of safety of clinically used atypical antipsychotics
Atypical antipsychotics show a superior safety and tolerability profile compared to conventional antipsychotics, but their metabolic side effects may limit their use in certain clinical samples.
Systematic ReviewHighly Cited
2016·
117citations
·L. Orsoliniet al.Expert Opinion on Drug Safety
9
9
Dose-Response Meta-Analysis of Antipsychotic Drugs for Acute Schizophrenia.
The 95% effective doses of antipsychotic drugs for acute schizophrenia are as follows:
Meta-AnalysisHighly Cited
2019·
177citations
·S. Leuchtet al.The American journal of psychiatry
10
10
Antipsychotics: Mechanisms underlying clinical response and side-effects and novel treatment approaches based on pathophysiology
Antipsychotics primarily target striatal dopamine D2 receptors, but new treatments targeting dopamine synthesis and storage may improve efficacy and reduce side-effects.
Rigorous JournalHighly Cited
2020·
227citations
·S. Kaaret al.Neuropharmacology