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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Medication seems to improve the long-term outcome for most people with schizophrenia. After 10 years of drug treatment, 25% of people with schizophrenia completely recover, 25% experience considerable improvement, and 25% experience modest improvement.

It is important for people with schizophrenia to continue with their drug treatment, even after recovery from an acute episode. The one-year relapse rate is about 80% for those who stop taking their medications after an acute episode. For those who continue to take their medications, the one-year relapse rate is only about 30%.

Neuroleptics remain the treatment of choice for schizophrenia. They are divided into two separate classes, typical antipsychotics, which are the older and less expensive medications, and atypical antipsychotics, which are newer and more expensive.

It is important to understand that there are risks and benefits with every medication. Patients may need to try more than one drug or combine medications to get the right treatment.

Common names include:

  • Chlorpromazine (Thorazine)
  • Fluphenazine (Prolixin)
  • Haloperidol (Haldol)
  • Thiothixene (Navane)
  • Trifluoperazine (Stelazine)
  • Perphenazine (Trilafon)
  • Thioridazine (Mellaril)

Typical antipsychotics are often very effective in treating certain symptoms (commonly referred to as “positive symptoms”) of schizophrenia, particularly hallucinations and delusions. Unfortunately, they may not be as helpful with other symptoms (known as “negative symptoms”), such as reduced motivation, apathy, and a lack of emotional expressiveness.

Typical antipsychotics can produce side effects that resemble the more difficult to treat “negative” symptoms. Often, lowering the dose or switching to a different medicine may reduce these side effects. Patients may have difficulty complying with these medicines as they may produce significant side effects.

Possible side effects of typical antipsychotics include:

  • Drowsiness and fatigue
  • Restlessness
  • Muscle spasms
  • Tremor
  • Dry mouth
  • Blurring of vision
  • Sexual dysfunction and/or loss of libido (interest in sex)
  • Sudden drop in blood pressure (hypotension)
  • Gastrointestinal problems (nausea, vomiting, diarrhea, constipation, heartburn)
  • Galactorrhea (the production of milk, particularly in males)
  • Gynecomastia (the appearance of breast tissue in males)
  • Difficulty with urination

Many of these side effects can often be corrected by lowering the dosage or controlled by the addition of other medications. Patients may have unique responses and experience different side effects to various antipsychotic drugs.

A possible, serious, long-term side effect with any typical antipsychotic is tardive dyskinesia (TD). TD is a disorder characterized by involuntary movements, most often affecting the mouth, lips, and tongue, and sometimes the trunk or other parts of the body such as arms and legs.

In most cases, the symptoms of TD are mild, and the patient may be unaware of the movements. When the symptoms are severe, though, they can be disconcerting to both the patient and others. In this case, the patient may be switched to a different antipsychotic. The course of TD is extremely variable. If detected early, the chance of the side effect becoming milder or disappearing is greatly increased. Unfortunately, for many patients, the abnormal movements seen in TD are permanent.

Common names include:

  • Risperidone (Risperdal)
  • Clozapine (Clozaril)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)
  • Aripiprazole (Abilify)
  • Iloperidone (Fanapt)
  • Paliperidone (Invega)

Atypical antipsychotics are equally effective in treating the positive symptoms of schizophrenia, such as hallucinations and delusions. Unlike typical antipsychotics, atypical antipsychotics may also treat the negative symptoms of schizophrenia, such as apathy, listlessness, restlessness, and social withdrawal. There is also evidence that some atypical antipsychotics are effective at treating depression.

Atypical antipsychotics tend to have fewer dyskinetic side effects than typical psychotics. It may take several weeks to months before atypical antipsychotics produce the desired treatment effects. There is recent evidence to suggest that this type of medication can produce a significant amount of weight gain (with the exceptions of ziprasidone and aripiprazole). Atypical antipsychotics also have been linked to the development of diabetes, increased cholesterol and triglycerides, and metabolic syndrome.

Clozapine, the first atypical antipsychotic developed, is a very effective treatment for schizophrenia. The drug's use has been limited because approximately 1% of individuals who take it will develop a life threatening side effect called agranulocytosis (a severe decrease in the white blood cell count), which can make one highly susceptible to developing infections. Clozapine is only used if a patient has not responded to two adequate trials of other antipsychotics. Any patient taking clozapine is required to have their blood drawn weekly in order to monitor white blood cell counts.

Possible side effects of typical antipsychotics include:

  • Weight gain
  • Increase in cholesterol, triglycerides, and blood sugar
  • Metabolic syndrome
  • Diabetes
  • Low blood pressure
  • Drowsiness
  • Constipation
  • Sexual dysfunction and/or loss of libido
  • Galactorrhea (primarily seen with risperidone)
  • Tardive dyskinesia (The exact risk of developing TD with the use of atypical antipsychotics has not yet been determined.)

Antipsychotic medications, in rare cases, can cause a condition called neuroleptic malignant syndrome (NMS). This life-threatening condition can occur in up to 1% of people taking these medications. It typically occurs within the first 2 weeks of treatment, but can occur later. Symptoms include fever, sweating, muscle stiffness, and dizziness. This condition requires immediate medical care.

Compliance with medicine tends to be a problem in people with schizophrenia for a variety of reasons. Fortunately, there are many strategies that patients, doctors, and families can use to improve adherence and prevent worsening of the illness. Some antipsychotic medications, including haloperidol (Haldol), fluphenazine (Prolixin), perphenazine (Trilafon), risperidone (Risperdal), and others, are available in long-acting injectable forms that eliminate the need to take pills every day.

Medication calendars or pillboxes labeled with the days of the week can help patients and caregivers know when medications have or have not been taken. Using electronic timers that beep when medications should be taken, or pairing medication with routine daily events like meals, can help patients remember and adhere to their dosing schedule. Encouraging family members to actually observe daily medication intake can greatly increase adherence. In addition, to these adherence strategies, patient and family education about schizophrenia is an important part of any successful treatment process.

Contact a doctor if the patient experiences any unwanted and/or persistent side effects, or if you feel that the patient is not improving with the prescription medications.

If you are taking medications, follow these general guidelines:

  • Take your medication as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what the results and side effects. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medication and herb or dietary supplements.
  • Plan ahead for refills so you do not run out.
References:

Brasic JR, Barnett JY, et al. Clinical assessment of adventitious movements. Psychol Rep. 1998;83(3 Pt 1):739-750.

Calabrese J, Keck P, et al. A randomized double blind placebo controlled trial of quetiapine in the treatment of bipolar I or II depression. Am J Psychiatry. 2005;162:1351-1360.

Dixon L, Perkins D, et al. Guideline watch: practice guideline for the treatment of patients with schizophrenia. American Psychiatric Association website. Available: http://www.psychiatryonline.com/content.aspx?aid=501001. Published 2009. Accessed September 6, 2010.

Lieberman JA, Stroup T, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. NEJM. 2005;353:1209-1223.

Mental health medications. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml#pub4. Accessed December 14, 2009.

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, PA: Elservier Mosby; 2004.

National Alliance on Mental Illness website. Available at: http://www.nami.org.

National Institute of Mental Health website. Available at: http://www.nimh.nih.gov.

Newcomer JW. Metabolic consideration in the use of antipsychotic medications: a review of recent evidence. J Clin Psychiatry. 2007;68(suppl 1):20-27.

Professional Guide to Diseases. 9th ed. Ambler, PA: Lippincott Williams & Wilkins; 2009.

Reynolds GP. Metabolic syndrome and schizophrenia. Br J Psychiatry. 2006;188:86.

Stern TA, et al. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Mosby Elsevier; 2008.

USP DI. 21st ed. Englewood, CO: Micromedex; 2001.

Yumru MH, Savas HA, et al. Atypical antipsychotics related metabolic syndrome in bipolar patients. J Affect Disord. 2006;98:247-252.

Last reviewed November 2012 by Rimas Lukas, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.