Loxapine is being rediscovered as a well-tolerated first-generation antipsychotic (FGA).

Iloperidone is not recommended as a first-choice antipsychotic due to twice-daily dosing, slow titration requirements, QT prolongation (similar to ziprasidone), dizziness, moderate weight gain, increased blood sugar, and overall weaker efficacy compared to other agents.

Cobenfy is a novel antipsychotic that acts through the muscarinic acetylcholine system rather than the traditional dopamine pathways.

Tried and true, risperidone’s moderate side effect profile has led to its wide use, and many clinicians consider it their antipsychotic of choice for first-episode psychotic disorders. 

Many consider olanzapine to be more effective than other antipsychotics and just below clozapine in overall efficacy. Its strong effectiveness, once-daily dosing, and low QT-prolongation risk are appealing.

Ziprasidone has an appealing weight and metabolic profile, but many clinicians are overly cautious due to its reputation for QT interval prolongation.

Trifluoperazine, like thiothixene (Navane), is an effective older agent with similar potency to haloperidol or fluphenazine; however, given the wide range of antipsychotic options today, it is rarely used.

Thiothixene is one of the original high-potency first-generation antipsychotics (FGAs)—but most clinicians prefer fluphenazine or haloperidol due to greater familiarity and more formulation options (liquid, injectable, long-acting).