Weight gain | Glucose abnormalities | Hyperlipidemia | Akathisia | Parkinsonism | Dystonia | Tardive dyskinesia | Prolactin elevation | Sedation | Anticholinergic | Orthostatic hypotension | QTc prolongation | |
Second-generation agents | ||||||||||||
Aripiprazole | + | + | + | ++ | + | + | + | + | + | + | + | * |
Asenapine | ++ | ++ | ++ | ++ | + | ++ | ++ | ++ | ++ | + | +/++ | + |
Brexpiprazole¶ | + | + | ++ | ++ | + | + | + | + | ++ | + | + | * |
Cariprazine¶ | ++ | + | + | ++ | + | + | + | + | ++ | ++ | + | * |
ClozapineΔ | +++ | +++ | +++ | + | + | + | + | + | +++ | +++ | +++ | ++ |
Iloperidone | ++ | ++ | + | + | + | + | + | ++ | ++ | + | +++ | ++◊ |
Lumateperone¶ | + | + | + | + | + | + | + | + | + | + | + | * |
Lurasidone | + | ++ | ++ | ++ | ++ | ++ | ++ | + | ++ | + | + | * |
Olanzapine | +++ | +++ | +++ | ++ | ++ | + | + | ++ | +++ | ++ | ++ | ++ |
Paliperidone | ++ | + | ++ | ++ | ++ | ++ | ++ | +++ | ++ | + | ++ | + |
Pimavanserin | – | + | + | + | + | + | + | + | + | + | ++ | + |
Quetiapine | ++ | ++ | +++ | + | + | + | + | + | +++ | ++ | ++ | +++ |
Risperidone | ++ | ++ | + | +++ | +++ | ++ | ++ | +++ | ++ | + | ++ | ++ |
Ziprasidone | + | + | + | ++ | + | + | + | ++ | ++ | + | ++ | +++ |
Other antipsychotic medications | ||||||||||||
Xanomeline-trospium¶ | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | + | +++ | + | 0 |
First-generation agents | ||||||||||||
Chlorpromazine | ++ | ++ | + | ++ | ++ | ++ | +++ | + | +++ | +++ | +++ | +++ |
Fluphenazine | ++ | + | + | +++ | +++ | +++ | +++ | +++ | + | + | + | + |
Haloperidol | ++ | + | + | +++ | +++ | +++ | +++ | +++ | + | + | + | Oral: ++ IV: +++ |
Loxapine | + | + | + | ++ | ++ | ++ | ++ | ++ | ++ | ++ | ++ | * |
Molindone | + | + | + | ++ | ++ | ++ | ++ | ++ | ++ | + | + | * |
Perphenazine | ++ | + | + | ++ | ++ | ++ | ++ | ++ | ++ | ++ | ++ | * |
Pimozide | + | + | + | +++ | +++ | ++ | +++ | +++ | + | + | + | ++ |
Thioridazine§ | ++ | + | + | + | + | + | + | ++ | +++ | +++ | +++ | +++ |
Thiothixene | + | + | + | +++ | +++ | +++ | +++ | +++ | + | + | + | * |
Trifluoperazine | ++ | + | + | ++ | ++ | ++ | ++ | ++ | + | ++ | + | * |
ECG: electrocardiogram; IV: intravenous.
* Clinically significant QTc prolongation was not detected in preliminary studies or reported in the manufacturer's labeling.
¶ Based upon limited experience.
Δ Clozapine also causes granulocytopenia or agranulocytosis in approximately 1% of patients requiring regular blood cell count monitoring. Clozapine has been associated with excess risk of myocarditis and venous thromboembolic events including fatal pulmonary embolism. These issues are addressed in the UpToDate topic review of guidelines for prescribing clozapine section on adverse effects.
◊ Available data suggest that iloperidone QTc risk is relatively low (+) at usual therapeutic doses. However, moderate QTc prolongation may occur at high doses and with interacting medications; caution (eg, regular ECG monitoring or avoidance) is warranted, particularly in high-risk patients.
§ Thioridazine is also associated with dose-dependent retinitis pigmentosa. Refer to UpToDate text.