Comparative Risk of Adverse Effects of Antipsychotic Medications


Adverse effect Low-potency FGAs† High-potency FGAs‡ SGAs
Aripiprazole (Abilify) Clozapine (Clozaril) Olanzapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon)

Anticholinergic effects

+++

+

0

+++

+

+

0

0

Dyslipidemia

++

+

0

+++

+++

++

+

0

Extrapyramidal symptoms

+

+++

+

0

+

0

++

+

Hyperprolactinemia

++

+++

0

0

+

0

+++

+

Neuroleptic malignant syndrome

+

++

+

+

+

+

+

+

Postural hypotension

+++

+

+

+++

+

++

++

+

Prolonged QT interval

++§

+

+

+

+

+

+

++

Sedation

+++

+

+

+++

++

++

+

+

Seizures

+

+

+

+++

+

+

+

+

Sexual dysfunction

+++

++

+

+

+

+

++

+

Type 2 diabetes mellitus

+

+

+

++

++

+

+

+

Weight gain

++

+

0

+++

+++

++

++

0


note: 0 = rare; + = lower risk; ++ = medium risk; +++ = higher risk.

FGAs = first-generation antipsychotics; SGAs = second-generation antipsychotics.

*— Effects are approximate, and relative to other antipsychotic medications rather than absolute risk of an adverse effect occurring.

†— FGAs with lower potency dopamine D2 neuroreceptor blockade, including chlorpromazine and thioridazine.

‡— FGAs with higher potency dopamine D2 neuroreceptor blockade. These include fluphenazine, haloperidol (formerly Haldol), thiothixene (Navane), neuroreceptor blockade, with an adverse and trifluoperazine. Please note that the FGA perphenazine is considered to have intermediate dopamine D2 effect profile between the low- and high-potency FGAs.

§— Individually, thioridazine has a higher risk of prolonged QT interval and should be used only when no other appropriate options are available.