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Antipsychotic Drugs: Summary of Recommendations

Antipsychotic drugs help many people with schizophrenia by suppressing their psychotic symptoms and enabling them to live more meaningful, stable lives with fewer relapses and reducing the need for hospitalization.  But this class of medicines has significant limitations. A sizable percentage of people with schizophrenia get little or no benefit when they take an antipsychotic, and others get only a partial reduction in symptoms. Also, side effects pose a major barrier to continuous use. In one major study, for example, three of every four people stopped taking an antipsychotic or switched to a different one within 18 months.

Newer and quite expensive antipsychotics marketed heavily to doctors and consumers over the past 15 years have largely eclipsed an older generation of drugs developed in the 1950s and 1960s. Research for years appeared to indicate that the newer drugs were better, largely because they had fewer side effects. But more recent large-scale studies now indicate that overall, the older drugs work just as well at a far lower cost.

  Our analysis focused on the use of these drugs in adults. Taking effectiveness, safety, side effects, patient variability, dosing convenience, and cost into account, we have chosen the following as Consumer Reports Best Buy Drugs to treat people with schizophrenia:
  • Generic perphenazine — for patients with schizophrenia who are not satisfied with their current treatment and whose doctor thinks perphenazine is worth a try. People taking perphenazine should be monitored closely for muscle tremors and spasms.
  • Generic risperidone — for people with schizophrenia who take perphenazine first and get minimal benefit and/or experience intolerable side effects.
  • Olanzapine (Zyprexa) — for certain people with schizophrenia who take perphenazine first and receive no benefit (or a minimal one) and/or experience intolerable side effects. Zyprexa is not a good option for people who are overweight or have blood sugar abnormalities, diabetes, or heart disease.
  • Generic clozapine — for people with moderate to severe schizophrenia who have not responded at all to two or more antipsychotics and have had little reduction in symptoms.

The choice of generic perphenazine—if a person responds well to it—could save you hundreds of dollars a month (adding up to thousands of dollars each year) compared with Zyprexa and Risperdal, the brand-name version of risperidone, depending on the dose required.

We are unable to make a Best Buy selection between antipsychotics for people with bipolar disorder. Unfortunately, there is not enough evidence to do so.

This information was last updated in August 2009.

Antipsychotic Drugs: Drug Comparison
The older drugs are in italics. The newer ones are in regular text.*
CR Best Buy Generic Name and Strength Brand Name Number of tablets or capsules per day1 Total Daily Dose Average Monthly Cost2 Compare Prices
Aripiprazole target daily dose = 10 mg -15 mg
  Aripiprazole 10 mg tablet Abilify One 10 mg $589
  Aripiprazole 15 mg tablet Abilify One 15 mg $576
  Aripiprazole 10 mg dissolvable tablet Abilify One 10 mg $707
  Aripiprazole 15 mg dissolvable tablet Abilify One 15 mg $597
Chlorpromazine target daily dose = 200 mg
  Chlorpromazine 100 mg tablet Generic Two 200 mg $38
  Chlorpromazine 200 mg tablet Generic One 200 mg $23
Clozapine target daily dose = 300 mg - 450 mg
Clozapine 100 mg tablet Generic Three 300 mg $279
  Clozapine 100 mg tablet Clozaril Three 300 mg $690
Clozapine 200 mg tablet Generic Two 400 mg $398
  Clozapine 100 mg dissolvable tablet Fazaclo ODT Three 300 mg $618
Haloperidol target daily dose = 0.5 mg - 5 mg two or three times daily
  Haloperidol 0.5 mg tablet Generic Two-Three 1 mg - 1.5 mg $14-$21
  Haloperidol 1 mg tablet Generic Two-Three 2 mg - 3 mg $14-$21
  Haloperidol 2 mg tablet Generic Two-Three 4 mg - 6 mg $16-$24
  Haloperidol 5 mg tablet Generic Two-Three 10 mg - 15 mg $18-$27
Iloperidone target daily dose = 12 mg - 24 mg
  Iloperidone 6 mg tablet Fanapt Two 12 mg Price not available
  Iloperidone 8 mg tablet Fanapt Two 16 mg Price not available
  Iloperidone 10 mg tablet Fanapt Two 20 mg Price not available
  Iloperidone 12 mg tablet Fanapt Two 24 mg Price not available
Loxapine target daily dose = 20 mg - 60 mg
  Loxapine 10 mg capsule Generic Two-Three 20 mg - 30 mg $68-$102
  Loxapine 25 mg capsule Generic One-Two 25 mg - 50 mg $48-$96
  Loxapine 50 mg capsule Generic One 50 mg $68
Molindone target daily dose = 100 mg
  Molindone 25 mg tablet Moban Four 100 mg $552
  Molindone 50 mg tablet Moban Two 100 mg $260
Olanzapine target daily dose = 10 mg
Olanzapine 10 mg tablet Zyprexa One 10 mg $546
  Olanzapine 10 mg dissolvable tablet Zyprexa, Zydis One 10 mg $641
Paliperidone target daily dose = 6 mg
  Paliperidone 6 mg sustained release tablet Invega One 6 mg $532
Perphenazine target daily dose = 4 mg - 8 mg three times daily
Perphenazine 2 mg tablet Generic Three 6 mg $75
Perphenazine 4 mg tablet Generic Three 12 mg $102
Perphenazine 8 mg tablet Generic Three 24 mg $117
Quetiapine target daily dose range = 300 mg - 400 mg
  Quetiapine 100 mg tablet Seroquel Three 300 mg $549
  Quetiapine 200 mg tablet Seroquel Two 400 mg $688
  Quetiapine 300 mg tablet Seroquel One 300 mg $442
  Quetiapine 400 mg tablet Seroquel One 400 mg $517
Quetiapine sustained release target daily dose = 400 mg-800 mg
  Quetiapine 400 mg sustained release tablet Seroquel XR One-Two 400 mg $511-$1022
Risperidone target daily dose = 2 mg - 8 mg
Risperidone 1 mg tablet Generic Two 2 mg $256
Risperidone 1 mg dissolvable tablet Generic Two 2 mg $406
  Risperidone 1 mg tablet Risperdal Two 2 mg $450
  Risperidone 1 mg orally dissolvable tablet Risperdal Two 2 mg $616
Risperidone 2 mg tablet Generic One-Two 2 mg - 4 mg $206-$412
Risperidone 2 mg orally disintegrating tablet Generic One-Two 2 mg - 4 mg $296-$592
  Risperidone 2 mg tablet Risperdal One-Two 2 mg - 4 mg $382-$764
  Risperidone 2 mg orally disintegrating tablet Risperdal One-Two 2 mg - 4 mg $431-$862
Risperidone 3 mg tablet Generic One-Two 3 mg - 6 mg $238-$476
Risperidone 3 mg orally disintegrating tablet Generic One-Two 3 mg - 6 mg $369-$738
  Risperidone 3 mg tablet Risperdal One-Two 3 mg-6 mg $425-$850
  Risperidone 3 mg orally disintegrating tablet Risperdal One-Two 3 mg-6 mg $548-$1,096
Risperidone 4 mg tablet Generic One-Two 4 mg-8 mg $327-$654
Risperidone 4 mg orally disintegrating tablet Generic One-Two 4 mg-8 mg $479-$958
  Risperidone 4 mg tablet Risperdal One-Two 4 mg-8 mg $601-$1,202
  Risperidone 4 mg orally disintegrating tablet Risperdal One-Two 4 mg-8 mg $717-$1,434
Thiothixene target daily dose = 20 mg - 30 mg
  Thiothixene 10 mg capsule Generic Two-Three 20 mg - 30 mg $34-$51
Trifluoperazine target daily dose = 15 mg - 20 mg
  Trifluoperazine 5 mg Generic Three 15 mg $66
  Trifluoperazine 10 mg Generic Two 20 mg $62
Ziprasidone target daily dose = 20 mg - 80 mg twice daily
  Ziprasidone 20 mg capsule Geodon Two 40 mg $538
  Ziprasidone 40 mg capsule Geodon Two 80 mg $518
  Ziprasidone 60 mg capsule Geodon Two 120 mg $628
  Ziprasidone 80 mg capsule Geodon Two 160 mg $622
* For the first-generation drugs - names are listed in italics - only the monthly costs of the generics are given, except for molindone (Moban); no generic of Moban is yet available. Over 90 percent of the prescriptions for these drugs are generic.
1. As typically prescribed for schizophrenia. The dose ranges come from the FDA approved labels (package inserts) for these drugs. All the antipsychotics are prescribed in a wide range of doses to meet patients' individual needs. Most people are started on low doses to gauge their response and experience of side effects. The dose is then usually increased, sometimes substantially. We have used the dose that the drugs' labels have stated as being effective for most patients.

2. Prices reflect nationwide retail average for May 2009, rounded to the nearest dollar. Information derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Health, Pharmaceutical Audit Suite®. Wolters Kluwer Health is not involved in our analysis or recommendations.