Atypical antipsychotics work by reducing dopamine in the brain. Each medication has its own side effects, indications, and dosage recommendations.

If you’ve been diagnosed with schizophrenia, you’ve likely been prescribed an “atypical” antipsychotic medication.

Atypical, or second-generation, antipsychotics appeared in the 1980s as an alternative to the previous generation of “typical” antipsychotics, which have been in use since the 1950s.

While atypical antipsychotics have mostly replaced the typical antipsychotics due to their much lower risk for certain severe side effects, the previous generation is still used for severe psychosis.

Most symptoms of schizophrenia have been linked to abnormal levels of dopamine, a neurotransmitter involved in mood, motivation, attention, and the regulation of body movements.

For example, schizophrenia’s “positive” symptoms, such as hallucinations and delusions, are linked to too much dopamine activity in certain parts of the brain. While the “negative” symptoms, such as the lack of emotional expression, are tied to too little dopamine.

Typical antipsychotics are good at reducing dopamine in the brain, which can help treat the positive symptoms, but they do little for — and can even worsen — the negative symptoms.

In addition, these drugs can reduce dopamine so much that it causes an imbalance in the brain leading to serious movement and coordination problems known as extrapyramidal symptoms (EPS).

EPS includes:

  • dystonia (involuntary movements like muscle contractions and spasm that can affect different parts of the body, including the eyes, neck, or legs)
  • Parkinsonism (tremors, rigidity)
  • akathisia (severe restlessness)

These issues led researchers to search for a better antipsychotic, which ultimately led to the emergence of atypical antipsychotics, the first of these being clozapine.

This newer class of antipsychotics seems to reduce just enough dopamine to treat the positive symptoms of schizophrenia but not enough to cause a high risk for EPS.

It’s believed that this is because atypical antipsychotics also block a serotonin receptor (5HT2a), which helps create a better balance of dopamine in the brain.

Atypicals may also be slightly better when it comes to negative symptoms, but evidence is mixed in this area.

Despite these benefits, atypical antipsychotics are more likely to cause weight gain and metabolic problems, such as diabetes.

But overall, their risk for severe side effects, such as EPS, is much lower than that of the previous generation.

Below is a list of common atypical antipsychotics for schizophrenia, their side effects, indications, and dosage recommendations. Keep in mind that you should follow your doctor’s dosage guidelines and never adjust the dosage of your medication without speaking with your treatment team first.

Common atypical antipsychotics for schizophrenia include:

  • aripiprazole / aripiprazole lauroxil (Abilify / Aristada)
  • clozapine (Clozaril)
  • lurasidone (Latuda)
  • olanzapine (Zyprexa)
  • paliperidone (Invega)
  • quetiapine (Seroquel)
  • risperidone (Perseris / Risperdal)
  • ziprasidone (Geodon)

Aripiprazole (Abilify) and aripiprazole lauroxil (Aristada) are atypical antipsychotics commonly used for adults with schizophrenia.

Aripiprazole lauroxil is a “prodrug” of aripiprazole, so a slightly different compound. When you take Aristada, your body turns aripiprazole lauroxil into aripiprazole. Aristada is available only as an injectable form given by a healthcare professional.

Abilify is available in the following forms:

  • a tablet
  • an orally disintegrating tablet
  • a solution
  • a tablet that contains a sensor (to notify if you’ve taken the drug)
  • an injectable form given by a healthcare professional

Side effects

Some common side effects of aripiprazole and aripiprazole lauroxil may include:

  • changes in weight; weight gain
  • headache
  • nausea
  • fatigue
  • anxiety
  • drooling
  • blurred vision
  • restlessness
  • drowsiness
  • sedation
  • lightheadedness
  • dizziness
  • sleep problems such as insomnia
  • constipation
  • cholesterol abnormalities

Indications

Apart from schizophrenia, aripiprazole is approved by the Food and Drug Administration (FDA) for the following conditions:

Aripiprazole may be prescribed “off-label” for borderline personality disorder or drug-induced hyperprolactinemia (increased prolactin levels caused by other antipsychotics).

Recommended dosage

Abilify (aripiprazole) comes in the following tablet/solution forms and dosages:

  • Abilify tablets: 2 milligrams (mg), 5 mg, 10 mg, 15 mg, 20 mg, 30 mg
  • Abilify oral disintegrating tablets: 10 mg, 15 mg
  • Abilify solution: 1 mg per milliliter (mL)
  • Abilify MyCite Tablet with a digestible sensor: 2 mg, 5 mg, 10 mg, 15 mg, 20 mg, 30 mg

Abilify tablets and suspension are usually taken once a day with or without food. Typically, treatment begins at a low dose and is increased slowly over several weeks.

The starting oral dose for adults with schizophrenia is typically 10 mg to 15 mg daily. It’s generally recommended that dosage increases not be made before 2 weeks. This is the time needed to achieve steady state.

For adolescents, the target dose of Abilify is 10 mg a day. Starting dosage will likely be lower.

Aripiprazole and aripiprazole lauroxil also come in extended release injectable suspensions:

  • Abilify Maintena extended-release injectable suspension: 300 mg, 400 mg. This is given once a month and requires a 2-week oral medication overlap.
  • Aristada (aripiprazole lauroxil) extended-release injectable suspension: 441 mg, 662 mg, 882 mg. Depending on the dose, Aristada is given once a month, every 6 weeks, or every 2 months. It requires a 3-week oral medication overlap.
  • Aristada Initio (aripiprazole lauroxil) extended-release injectable suspension: 675 mg. This is a one-time injection and is typically given with an oral dose of aripiprazole to start aripiprazole lauroxil injection treatment. This allows for a 1-day initiation and does not require further oral overlap.

Avoid drinking alcohol or using drugs while taking aripiprazole. These may decrease the benefits and increase the negative effects of the medication.

Clozapine (Clozaril) was the first atypical antipsychotic approved for the treatment of schizophrenia. Because it’s linked to severe side effects like agranulocytosis (low white blood cell count), its use is restricted to treatment-resistant schizophrenia.

Side effects

Some common side effects of clozapine (Clozaril) may include:

  • weight gain
  • dizziness
  • increased heart rate
  • low or high blood pressure
  • drowsiness
  • vertigo
  • insomnia
  • increased salivation
  • nausea
  • vomiting
  • constipation
  • fever
  • indigestion

Some evidence suggests that clozapine has a greater chance of weight gain than some other atypical antipsychotics. Another study shows it has the longest time to discontinuation, meaning people may take this medication longer than other atypical antipsychotics.

Indications

Apart from schizophrenia, clozapine (Clozaril) is FDA approved for the following conditions:

Clozapine (Clozaril) may also be prescribed off-label for people with Parkinson’s disease who have psychosis symptoms.

Recommended dosage

Clozapine comes in the following forms and dosages:

  • Clozaril tablets: 25 mg, 50 mg, 100 mg, 200 mg
  • FazaClo oral disintegrating tablets: 12.5 mg, 25 mg, 100 mg, 150 mg, 200 mg
  • Versacloz solution: 50 mg per mL

Clozapine is typically taken once or twice a day with or without food. It’s usually started at a low dose and increased slowly over several weeks.

Clozapine can sometimes reduce the number of white blood cells in your body. Because of this, you will need frequent blood tests to make sure your white blood cell count is standard. This is typically done weekly for 6 months, then biweekly for another 6 months, and then monthly for as long as you’re taking the medication.

Lurasidone (Latuda) is an atypical antipsychotic commonly prescribed to treat schizophrenia. It’s available as an immediate-release tablet.

Side effects

Some common side effects of lurasidone (Latuda) may include:

  • weakness
  • restlessness
  • dizziness, feeling unsteady, or having trouble keeping your balance
  • anxiety
  • increased saliva
  • tiredness
  • uncontrollable shaking
  • slow movements or shuffling walk
  • nausea or vomiting
  • appetite changes
  • breast enlargement or discharge
  • menstrual irregularities
  • reduced sexual ability

Indications

Apart from schizophrenia, lurasidone (Latuda) is FDA approved for the following conditions:

  • bipolar depression

Lurasidone (Latuda) may be prescribed off-label for:

  • bipolar mania
  • irritability and anger in autism spectrum disorder

Recommended dosage

Lurasidone comes in the following oral forms and dosages:

  • Immediate-release tablets: 20mg, 40 mg, 60 mg, 80 mg, and 120 mg

The typical starting dosage for schizophrenia in adults and adolescents is 40 mg a day. It is recommended that lurasidone (Latuda) be taken with a meal of at least 350 calories.

Olanzapine (Zyprexa) is an atypical antipsychotic often prescribed for schizophrenia. It’s available as:

  • an oral tablet
  • a disintegrating oral tablet
  • immediate-release injection
  • extended-release injection

Side effects

Some common side effects of olanzapine (Zyprexa) may include:

  • changes in weight; weight gain
  • low blood pressure
  • increased appetite
  • agitation
  • restlessness
  • dry mouth
  • back pain
  • headache
  • constipation
  • fatigue
  • drowsiness
  • insomnia
  • lightheadedness
  • increased prolactin
  • dizziness
  • stomach upset
  • dry mouth
  • abnormal gait
  • liver function test abnormalities

Some evidence suggests olanzapine (Zyprexa) may have a greater risk of weight gain than other atypical antipsychotics.

Indications

Apart from schizophrenia, olanzapine (Zyprexa) is FDA approved for the following conditions:

  • acute treatment of manic or mixed episodes of bipolar disorder
  • long-term maintenance treatment of bipolar disorder
  • acute treatment of agitation in schizophrenia and bipolar disorder

Olanzapine (Zyprexa) may also be used off-label for:

  • the prevention of chemotherapy-associated nausea or vomiting
  • delirium
  • delusional parasitosis
  • post-traumatic stress disorder (PTSD)
  • Tourette syndrome
  • anorexia nervosa

Recommended dosage

Olanzapine comes in the following forms and dosages:

  • Zyprexa tablets: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg and 20 mg
  • Zyprexa Zydix (orally disintegrating tablet): 5 mg, 10 mg, 15 mg, 20 mg

Zyprexa tablets are usually taken once a day with or without food. Typically, people begin taking Zyprexa at a low dose and increase the dose slowly over several weeks.

Olanzapine also comes in the following injection forms and dosages:

  • Zyprexa injection (immediate release): 10 mg vials
  • Zyprexa Relprevv Injection (extended release): 150 mg, 210 mg, 300 mg, 405 mg. This is typically administered every 2 to 4 weeks.

These injections are typically given every 2 to 4 weeks and require monitoring for 3 hours after each injection. This is the only injection that requires such extensive monitoring.

Paliperidone (Invega) is an atypical antipsychotic used to treat schizophrenia and schizoaffective disorder. It’s available as an extended-release tablet and an extended-release injection.

Side effects

Some common side effects of paliperidone (Invega) include:

  • restlessness
  • drowsiness
  • tachycardia (heart rate over 100 beats per minute)
  • headache
  • increased prolactin
  • vomiting
  • cholesterol abnormalities
  • tremors
  • increased glucose (blood sugar)

Indications

Apart from schizophrenia, paliperidone (Invega) is FDA approved to treat the following conditions:

  • schizoaffective disorder

Recommended dosage

Paliperidone is available in the following forms and dosages:

  • Invega extended-release tablets: 1.5 mg, 3 mg, 6 mg, 9 mg
  • Extended-release injectable suspension (Invega Sustenna): 39 mg, 78 mg, 117 mg, 156 mg, 234 mg. This formulation lasts for a month.
  • Extended-release injectable suspension (Invega Trinza): 273 mg, 410 mg, 546 mg, 819 mg. This formulation lasts for 3 months.

Tablets are usually taken once a day with or without food. People typically start at a low dosage and increase it slowly over several weeks.

Quetiapine (Seroquel) is an atypical antipsychotic used to treat schizophrenia. It’s available in immediate-release and extended-release tablets.

Side effects

Some common side effects of quetiapine (Seroquel) may include:

  • weight gain
  • increased heart rate
  • increased blood pressure
  • headache
  • agitation
  • drowsiness
  • dry mouth
  • increased appetite
  • constipation
  • fatigue
  • increased glucose (blood sugar)
  • cholesterol abnormalities

Indications

Apart from schizophrenia, quetiapine (Seroquel) is FDA approved for the following conditions:

  • acute treatment of mania and depression in bipolar disorder
  • long-term maintenance treatment of bipolar disorder(either alone or with lithium or valproate)
  • adjunctive treatment for major depressive disorder (when used with an antidepressant)

Quetiapine (Seroquel) may be prescribed off-label for:

Recommended dosage

Quetiapine is available in the following tablets and dosages:

  • Seroquel immediate-release tablet: 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg
  • Seroquel XR extended-release tablet: 50 mg, 150 mg, 200 mg, 300 mg, 400 mg

Quetiapine (Seroquel) is typically taken 1, 2, or 3 times a day with or without food. The extended-release should be taken without food or with a light meal that has fewer than or equal to 300 calories.

People taking quetiapine (Seroquel) usually begin at a low dose of medicine and the dose is increased slowly over several weeks.

Risperidone (Perseris / Risperdal) is an atypical antipsychotic commonly prescribed to treat schizophrenia. It’s available as:

  • a tablet
  • an oral disintegrating tablet
  • an oral solution
  • extended-release injectable suspensions

Side effects

Some common side effects of risperidone (Perseris / Risperdal) may include:

  • sleepiness
  • weight gain
  • constipation
  • insomnia
  • restlessness
  • anxiety
  • nausea
  • vomiting
  • drowsiness
  • headache
  • dizziness
  • fatigue
  • sore throat
  • drooling
  • coughing
  • lightheadedness
  • increased prolactin
  • cold symptoms

Indications

Apart from schizophrenia, risperidone (Perseris / Risperdal) is FDA approved for the following conditions:

  • acute treatment of manic or mixed episodes of bipolar disorder
  • long-term maintenance treatment of bipolar disorder
  • irritability associated with autism spectrum disorder

Risperidone (Perseris / Risperdal) may be prescribed off-label for:

Recommended dosage

Risperidone comes in the following oral forms and dosages:

  • Risperdal tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg
  • Risperdal orally disintegrating tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg
  • Solution: 1 mg per ml

Risperdal (risperidone) tablets and solution are typically taken once or twice a day with or without food. In general, people taking risperidone begin at a low dose of medicine and increase it slowly over several weeks.

Risperidone also comes in the following extended-release suspensions:

  • Risperdal Consta: Extended-release injectable suspension: 12.5 mg, 25 mg, 37.5 mg, 50 mg. This is typically administered by a healthcare professional every 2 weeks.
  • ​Perseris Extended-release injectable suspension: 90mg, 120 mg. This is administered by a healthcare professional every month.

Ziprasidone (Geodon) is an atypical antipsychotic used to treat schizophrenia. It’s available as a capsule and as an immediate-release injection (for acute agitation in schizophrenia).

Side effects

Some common side effects of ziprasidone (Geodon) may include:

  • drowsiness
  • headache
  • lightheadedness
  • cold symptoms
  • indigestion
  • nausea
  • diarrhea
  • weakness
  • dry mouth
  • dizziness
  • cough
  • involuntary muscle contractions or muscle tightness
  • upper respiratory infection
  • stuffy and runny nose

Indications

Apart from schizophrenia, ziprasidone (Geodon) is FDA approved for the following conditions:

  • acute treatment of manic or mixed episodes of bipolar disorder
  • acute treatment of agitation in schizophrenia
  • long-term maintenance treatment of bipolar disorder (when used with lithium or valproate)

Ziprasidone (Geodon) is sometimes prescribed off-label for schizoaffective disorder.

Recommended dosage

Ziprasidone is available in the following forms and dosages:

  • Capsules: 20 mg, 40 mg, 60 mg, 80 mg
  • Immediate-release injection: 20 mg per mL

Ziprasidone (Geodon) is usually taken twice a day with at least 500 calories of food. It’s typically started at a low dose and increased slowly over several weeks.

Atypical antipsychotics may have a lower risk of severe side effects than typical antipsychotics. They may also be slightly more effective for treating negative symptoms of schizophrenia.

If your doctor has prescribed you an atypical antipsychotic, it’s important to follow their dosage recommendations and speak with them if you feel your dosage needs adjusting or the medication isn’t helping you. If you’re experiencing side effects, discuss them with your treatment team. Together, you can devise a plan to help minimize side effects and maximize the effectiveness of the medication.

While schizophrenia is a challenging chronic condition, you can live a productive and fulfilling life with the right treatment plan and support.