Updated 09/10

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Medication Brand/Generic	Form	Dose Schedule	Dose Range	Most Common Side Effects for Group	Pros for Group	Cautions for Group
Risperdal (risperidone)	tablets .25mg .50mg 1mg 2mg 3mg 4mg M tabs 0.5, 1, 2mg liquid 1mg/1ml consta	1-3 times daily, often evening only	one quarter to 16mg/day depending on age, size, diagnosis, and severity.	Sedation, weight gain or appetite increase. Extrapyramidal symptoms (EPS - see page 1) less common than with "typicals." Prolactin increase also less common than typicals but also can occur especially with higher doses. Sun sensitivity, heat intolerance, sexual side effects uncommon. Rarely negative effects on liver or blood count.	The "Atypical" antipsychotics are often preferred over the "typicals" as first line treatments for the above conditions. The "Atypicals" have benefit for mood disorders and may even work as mood stabilizers. Generic risperidone is available. Invega is an extended smoother release cousin of risperidone (OROS).	Prolactin increase and breast discharge happens more with Risperdal than other atypicals. Appetite increase or sedation are often more of a concern than EPS or TD (good). Weight gain and related negative health effects occur most often with Zyprexa and Risperdal but least with Geodon.
Fanapt iloperidone	1, 2, 4, 6, 8, 10, 12mg tablets		6-12 mg twice daily
Invega (paliperidone)	Sustenna 3, 6, 9 mg caplets	Once a day or monthly	3 to 12 mg/d  (6 average)
Zyprexa (olanzapine)	tablets 2.5mg 5mg 7.5mg 10mg 15mg 20 mg zydis 5mg 10mg 15 mg 20 mg Injection	Once to twice a day, often evening only	1.25mg to 20mg/day	Zyprexa, Clozaril, and Seroquel have lowest risks of EPS.  Zyprexa, Clozaril, Risperdal, and Seroquel cause the most sedation and weight gain. Abilify and Saphris are in the middle. Geodon is lowest. Directly or indirectly weight gain can lead to diabetes, hypertension, and high cholesterol and triglycerides.	Risperdal and Zyprexa have been available longest, studied the most, have the best track records, are very effective (often rapidly) and have been used enough with kids and the elderly to have shown benefit and safety. No routine blood tests for any of the group.	All these "atypicals" except Risperdal are still under patent and are quite expensive. All antipsychotics block the dopamine (D2) receptor. The atypicals also somewhat block serotonin (5HT). Thus it is theoretically possible to increase anxiety or interfere with serotonin meds (SRI, Buspar). However, the atypicals also boost their effects in many cases (good).
Seroquel (quetiapine)	tablets 25, 50, 100, 200, 300, 400mg XR 50, 150, 200, 300, 400 mg	Twice daily, sometimes only evening	100mg to 800mg/day total	Seroquel has very low risks of EPS. This includes a very low risk of Tardive Dyskinesia (TD) and Neuroleptic Malignant Syndrome (MNS). Seroquel is not very potent. Thus higher doses are often needed.	In certain situations improved appetite and improved sleep are desired side effects. Side effects are often less at lower doses. Side effects can often be avoided completely. Sedation is most common.	Cataract risk may be increased slightly by all antipsychotics as well as by some other medicines and health conditions.
Geodon (ziprasidone)	capsules 20mg 40mg 60mg 80mg injection 20mg/ml	Twice a day, sometimes once	20 to 160mg/day total, usually	Geodon and Seroquel have shorter action and are thus advised to be given a.m. and evenings. Geodon reportedly causes the least weight gain of the group.	Geodon rarely, if ever, causes weight gain. It is also less likely to cause sedation. Geodon may worsen or bring out abnormal heart rhythm. Certain patients may thus be best off with one of the others. Checking an EKG may be worthwhile in some cases.	Geodon has a small chance of heart rhythm side effects.
Clozaril (clozapine)	tablets, scored 25mg 100mg	Once or twice daily	300 to 900mg a day, usually	A wide range of nuisance and moderate side effects render Clozaril a hassle too often. Blood count suppression can be dangerous so that weekly blood tests are advised at least at first.	Clozaril not only does not cause EPS, especially Tardive Dyskinesia (TD), it actually can treat TD. "Miraculous" benefits have occured with some cases of schizophrenia.	I generally do not use Clozaril because of side effects although it may be the most effective.
Abilify (ariprazole)	tablets 2, 5, 10, 15, 20, 30mg Discmelt 10, 15mg liquid 1mg/1ml	Once or twice daily	2 to 45 mg	Sleepy, dizzy, weight gain, nausea.	All Atypicals help psychosis, mania, and impulsive aggression.
Saphris (asenapine)	sublingual tablets 5, 10 mg	Once to often twice a day	5 to 30 mg a day usually 5 to 10mg twice a day	Like other atypicals. Moderate weight gain and metabolic changes. Sedation, EPS, akathisia, dizzy	FDA approved for schizophrenia and bipolar.	Youth studies and experience is just beginning.

Simultaneous use of alcohol or cigarettes and especially street drugs should be avoided. All medications should be avoided, if possible, in pregnancy.
This chart is intended to be a summary guide, not a full and complete list.