Pimavanserin is the only antipsychotic with virtually no dopamine receptor activity.

Perphenazine, first introduced in 1957, is an older first-generation antipsychotic (FGA) that became newly popular after the 2005 CATIE trial showed it to be as effective as most second-generation antipsychotics (SGAs) with minimal weight gain or metabolic problems. Many clinicians now consider it an effective, well tolerated, inexpensive alternative to SGAs.

Paliperidone is the active metabolite of risperidone.

Molindone is an effective, well-tolerated first-generation antipsychotic (FGA) of medium potency—a solid medication favored by some clinicians for select patients. It was recently reintroduced to the market and remains generic and inexpensive.

Lumateperone is the newest second-generation antipsychotic, approved for adults with schizophrenia or bipolar depression.

Haloperidol is an effective, inexpensive first-generation antipsychotic (FGA) with low weight gain potential and a long history of use, but its clinical utility is limited by extrapyramidal symptoms (EPS) and the risk of tardive dyskinesia.

Dr. Carlat and Dr. Puzantian have no financial relationships with companies related to this material.
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Asenapine’s unique advantage is its availability in both sublingual and transdermal patch formulations, making it useful for patients who cannot or prefer not to swallow pills.

Nefazodone was once popular due to its low rate of sexual side effects, but its use has dramatically declined because of rare yet serious hepatic toxicity.

Topiramate is a reasonable off-label choice for alcohol use disorder and antipsychotic-induced weight gain.