Some three million Americans have schizophrenia, a brain disorder characterized by disorganized thinking, agitation, and delusions. Another five million have bipolar disorder, the hallmark of which is sharp swings between very high moods—called mania—and very low moods—called depression. Drugs called antipsychotics are commonly used to treat people with these conditions, but choosing the right one can be a challenge.
To help patients, their families, and their doctors choose an antipsychotic, Consumer Reports has evaluated the drugs in this category based on their effectiveness, safety, and cost. This brief is a summary of a free 21-page report you can access on the Internet at www.CRBestBuyDrugs.org. Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
Who Needs an Antipsychotic?
Most people diagnosed with schizophrenia should try an antipsychotic. The drugs can help people with this condition live more meaningful, stable lives with fewer or no periods of hospitalization. Antipsychotics can also help people with bipolar disorder, but other types of drugs are better for the long-term management of that condition.
Antipsychotics can be effective for treating schizophrenia, but many people who take them receive little or no benefit or only a partial reduction in symptoms. Side effects also pose a major barrier to continuous use. Older, less expensive antipsychotics can work just as well as newer, more costly ones.
Taking effectiveness, safety, side effects, patient variability, dosing convenience, and cost into account, we have chosen the following as Consumer Reports Best Buy Drugs:
- Generic perphenazine—for people with schizophrenia who are not satisfied with their current treatment and whose doctor thinks perphenazine is worth a try. People taking perphenazine should be monitored closely for muscle tremors and spasms.
- Generic risperidone—for people with schizophrenia who take perphenazine first and get minimal benefit and/or experience intolerable side effects.
- Olanzapine (Zyprexa)—for certain people with schizophrenia who take perphenazine first and receive no benefit (or a minimal one) and/or experience intolerable side effects. Not a good option for people who are overweight or have blood sugar abnormalities, diabetes, or heart disease.
- Generic clozapine—for people with moderate to severe schizophrenia who had little to no reduction in symptoms despite trying two or more antipsychotics.
Generic perphenazine—if a person responds well to it—could save you thousands of dollars each year compared to Zyprexa and Risperdal, the brand-name version of risperidone, depending on the dose required.
We are unable to select an antipsychotic as a Best Buy for people with bipolar disorder. There is not enough evidence to do so.
This information was last updated in August 2009.
Minor to severe
These can diminish or disappear over time, or be reduced if dose is lowered. Most people have more than one of these.
- Abnormal body movements, muscle twitches, tremors
- Blurred vision
- Dry mouth
- Rapid heartbeat
- Sexual dysfunction
- Slurred speech
May be serious
These may require discontinuing the drug; in some cases, can become permanent.
- Agranulocytosis—decrease in disease-fighting white blood cells, which can lead to serious or fatal infections. (This risk is associated primarily with clozapine—regular blood tests are required with use—but it has also been reported with other antipsychotics.)
- Changes in metabolism that can lead to diabetes and a higher risk of heart disease and stroke.
- Myocarditis—an inflammation of the heart muscle that can be fatal. This risk associated primarily with clozapine.
- Neuroleptic Malignant Syndrome—characterized by high fever, increased heart rate, and blood pressure; can be fatal.
- Significant weight gain—7 percent or greater increase in body weight. Generally this is about 12 pounds or more.
- Tardive dyskinesia—characterized by uncontrollable body movement that may include tremors and spasms.
Generic Name and Strength1
Older drugs are in italics. Newer ones are in regular text.2
Number of Tablets or Capsules per Day3
Total Daily Dose
Average Monthly Cost4
Aripiprazole 10 mg tablet
Chlorpromazine 200 mg tablet
Clozapine 100 mg tablet
Clozapine 100 mg tablet
Clozapine 200 mg tablet
Clozapine 100 mg dissolvable tablet
Haloperidol 0.5 mg tablet
Two to Three
Iloperidone 8 mg tablet
Price not available
Loxapine 50 mg capsule
Molindone 50 mg tablet
Olanzapine 10 mg tablet
Olanzapine 10 mg dissolvable tablet
Paliperidone 6 mg sustained-release tablet
Perphenazine 2 mg tablet
Perphenazine 4 mg tablet
Perphenazine8 mg tablet
Quetiapine 100 mg tablet
Risperidone 1 mg tablet
Risperidone 1 mg dissolvable tablet
Risperidone 1 mg tablet
Thiothixene 10 mg capsule
Two to Three
Trifluoperazine 5 mg
Ziprasidone 20 mg capsule
Ziprasidone 60 mg capsule
Ziprasidone 80 mg capsule
1. Selected doses are listed due to space limitations. For a more complete listing, see our full report at: CRBestBuyDrugs.org.
2. For the first-generation drugs: names are listed in italics—only the monthly costs of the generics are given, except for molindone (Moban); no generic of Moban is yet available. Over 90 percent of the prescriptions for these drugs are generic.
3. As typically prescribed for schizophrenia. The dose ranges come from the FDA-approved labels (package inserts) for these drugs. All the antipsychotics are prescribed in a wide range of doses to meet patients’ individual needs. Most people are started on low doses to gauge their response and experience of side effects. The dose is then usually increased, sometimes substantially. We have used the dose that the drugs’ labels have stated as being effective for most patients.
4. Prices reflect nationwide retail average for May 2009, rounded to the nearest dollar. Information derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.
NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health-care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, non-commercial use and may not be used in advertising, promotion, or for any other commercial purpose.
Copyright 2010, Consumers Union of United States, Inc