Handouts · Medications
Second-Generation (Atypical) Antipsychotics
Includes risperidone, olanzapine, quetiapine, aripiprazole, lurasidone, ziprasidone, paliperidone, and cariprazine. Used for psychosis, bipolar disorder, and as add-ons for depression.
What This Group Is
These medicines calm the brain’s dopamine and serotonin signals. They treat schizophrenia, bipolar disorder, and severe agitation, and some are add-ons for depression.
They are less likely than older antipsychotics to cause stiffness and tremor, but more likely to affect weight and metabolism.
How to Take It
Take once or twice daily as prescribed. Some have food rules: ziprasidone needs a 500-calorie meal and lurasidone needs at least 350 calories to absorb well.
Many are sedating and are taken at bedtime. Do not stop suddenly.
Black Box Warning
Not approved for dementia-related psychosis in older adults — use in that setting raises the risk of death (mostly heart and infection causes).
Antidepressant-style suicidality warnings also apply when these are used for depression in people under 25.
Common (Usually Mild) Side Effects
- Drowsiness, dizziness on standing.
- Increased appetite and weight gain.
- Restlessness (akathisia) — an urge to keep moving.
- Dry mouth or constipation; risperidone can raise prolactin (breast changes, cycle changes).
Serious — Call Us or Seek Care
- Metabolic problems: new diabetes (excess thirst/urination), high cholesterol.
- Tardive dyskinesia: lasting involuntary movements of the face, tongue, or limbs.
- Neuroleptic malignant syndrome (NMS): high fever, severe stiffness, confusion — an emergency.
- Fainting, or an irregular heartbeat (especially with ziprasidone).
Alcohol
Avoid or strictly limit alcohol — it adds to drowsiness and dizziness and can worsen the underlying condition.
Recommended Monitoring
These medicines call for regular metabolic and movement checks:
• Weight / BMI / waist — at baseline and follow-ups
• Fasting glucose or A1c — for diabetes
• Cholesterol and triglycerides (lipids)
• Blood pressure
• Movement screening (AIMS) for tardive dyskinesia
• EKG for some (e.g., ziprasidone) or if you have heart risks