Benztropine is an anticholinergic medication that is the go-to agent for treating and preventing antipsychoticinduced extrapyramidal symptoms (EPS). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Avanafil is the newest PDE-5 inhibitor to come to market. Its potential advantage is a somewhat faster onset than any of the other ED drugs. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Cariprazine, like aripiprazole and brexpiprazole, is a partial dopamine agonist. Some preliminary data imply that it might be effective for negative symptoms, but it’s too soon to tell. Beyond that, it appears similar to the other two partial dopamine agonists with regard to akathisia and minimal weight gain. It is available as a brand name only and is therefore very expensive (as opposed to aripiprazole, which has gone generic). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Rapid regular movements of body parts, especially hands. Classified as fine vs coarse, and as resting vs postural vs intention. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Involuntary grinding of teeth, which especially occurs during sleep but can also occur in the daytime. In 5% of cases this can cause severe health problems, such as destruction of tooth structure, temporomandibular joint dysfunction, myofascial pain, and sleep disturbances. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Clomipramine, which has more side effects than SSRIs, is usually considered a second-line medication for OCD. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Brexpiprazole is a cousin of aripiprazole and is also a partial dopamine agonist. While it has a very similar efficacy profile to aripiprazole, it was recently awarded approval for treatment of agitation in Alzheimer’s dementia—the first drug to gain this indication. However, effect sizes were small, and safety in the elderly remains a concern. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Quetiapine’s low risk for EPS and broad spectrum of efficacy make it an appealing first-choice agent. However, sedation, weight gain, and orthostasis may limit use. Dosing at bedtime, or switching to XR, may help reduce daytime sedation. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Excessive drooling, usually more severe at night. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Solriamfetol is a wakefulness promoter with a different mechanism of action from modafinil and armodafinil. Patients may ask you about it given all the TV ads, but time will tell how it compares with these more established (and cheaper) agents. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).