What are the medications for schizophrenia?

From the Guidelines

Antipsychotic medication is the primary treatment for schizophrenia, and patients should be treated with an antipsychotic medication and monitored for effectiveness and side effects. The American Psychiatric Association recommends that patients with schizophrenia be treated with an antipsychotic medication, and that patients whose symptoms have improved with an antipsychotic medication continue to be treated with an antipsychotic medication 1.

Key Considerations

• First-generation (typical) antipsychotics, such as haloperidol and chlorpromazine, and second-generation (atypical) options, like risperidone, olanzapine, quetiapine, aripiprazole, and clozapine, are available for treatment.
• Treatment usually begins with a low dose that may be gradually increased until symptoms improve, with maintenance therapy continuing for years or indefinitely to prevent relapse.
• Clozapine is typically reserved for treatment-resistant cases, and is recommended for patients with treatment-resistant schizophrenia or those at substantial risk for suicide attempts or suicide despite other treatments 1.

Psychosocial Interventions

• Alongside medication, psychosocial interventions like therapy, social skills training, and family support are important components of comprehensive schizophrenia treatment.
• The American Psychiatric Association recommends that patients with schizophrenia receive cognitive-behavioral therapy for psychosis, psychoeducation, supported employment services, and assertive community treatment if there is a history of poor engagement with services leading to frequent relapse or social disruption 1.

Antipsychotic Polypharmacy

• Antipsychotic polypharmacy, or the concurrent use of two or more antipsychotic medications, may be considered in certain cases, such as for patients with treatment-resistant schizophrenia or those who have not responded to monotherapy 1.
• However, antipsychotic polypharmacy should be used with caution, as it may increase the risk of side effects, and patients should be closely monitored for effectiveness and side effects.

Monitoring and Adjustment

• Treatment should be supervised by a psychiatrist who can monitor effectiveness and side effects, adjusting medication as needed.
• Patients should be regularly assessed for symptoms, side effects, and overall functioning, and treatment plans should be adjusted accordingly.

From the FDA Drug Label

A second traditional assessment, the Clinical Global Impression (CGI), reflects the impression of a skilled observer, fully familiar with the manifestations of schizophrenia, about the overall clinical state of the patient. The efficacy of RISPERIDONE in the treatment of schizophrenia in adolescents aged 13–17 years was demonstrated in two short-term (6 and 8 weeks), double-blind controlled trials Quetiapine fumarate tablet is indicated for the treatment of schizophrenia.

Medications for Schizophrenia:

• Risperidone (PO): effective in the treatment of schizophrenia in adults and adolescents aged 13-17 years 2
• Quetiapine (PO): indicated for the treatment of schizophrenia in adults and adolescents (13 to 17 years) 3

From the Research

Medications for Schizophrenia

• Antipsychotics are the cornerstone of pharmacological treatment for schizophrenia, with 65 available medications classified into first-generation (conventional) agents and second-generation (atypical) agents 4.
• The choice of antipsychotic medication should be based on prior treatment response, individual preference, medical history, and individual patient vulnerabilities 4.
• Clozapine is found to be more efficacious than other agents among otherwise treatment-refractory schizophrenia patients, while other differences in efficacy between antipsychotic agents are minor 4.

Specific Medications

• Olanzapine, a second-generation antipsychotic, has proven efficacy against positive and negative symptoms of schizophrenia, with a lower risk of extrapyramidal symptoms compared to haloperidol 5.
• Risperidone, another second-generation antipsychotic, has been shown to be effective in treating schizophrenia, with a reduced risk of adverse events compared to haloperidol 5, 6.
• Long-acting injectable risperidone has been evaluated in stable patients with schizophrenia, showing improved efficacy and reduced extrapyramidal symptoms 6.

Treatment Strategies

• Antipsychotic polypharmacy may be helpful for difficult populations, but at the cost of adverse effects 7.
• Sequentially switching among olanzapine, quetiapine, and risperidone may be effective for patients with symptomatic schizophrenia, with some patients responding to the second or third agent 8.
• Algorithm-based antipsychotic pharmacotherapy can be effective in the real-world clinical setting, with a significant difference in response rates between olanzapine, quetiapine, and risperidone as the first choice 8.