Antipsychotic medicines for schizophrenia

Medicine is a core part of treatment for schizophrenia. The main medicines are called antipsychotics. They lower hallucinations, false beliefs and confused thinking, so a person can think more clearly and feel more like themselves.^1,2

Medicine works best together with therapy and support. This page explains the kinds of antipsychotics, what to expect, which side effects to watch for, and why stopping on your own is risky. It does not give doses. Your doctor chooses those for you.

How do antipsychotics help?

Most antipsychotics act on dopamine, a chemical messenger in the brain. They are thought to calm the signals that feed hallucinations and false beliefs.⁴ Nobody takes them to change who they are. The aim is to quiet the symptoms so daily life gets easier.

Medicine does not work the same for everyone. Some people feel much better. Others improve only partly. Often the first medicine is not the best fit, and the doctor tries another. Finding the right one can take time, so please do not lose hope early.²

Older and newer antipsychotics

Antipsychotics are often split into two groups. First-generation (also called "typical") medicines are the older ones, made in the mid-1900s. Second-generation (also called "atypical") medicines came later. Both groups work on dopamine, and neither group is better for everyone. The big difference is the side effects.⁴

Source for the table: NAMI.⁴ This is a general pattern. Each medicine is different, so ask about the one you are offered.

A newer kind of medicine

In September 2024, the FDA approved Cobenfy (xanomeline and trospium) for adults with schizophrenia. It is the first antipsychotic that targets cholinergic receptors (another type of brain signal) instead of dopamine receptors.⁶ Moderate evidence

In two 5-week studies, adults taking it had a meaningful drop in symptoms compared with placebo.⁶ The studies were short, so less is known about the long run. Common side effects include nausea, indigestion, constipation, vomiting, high blood pressure, fast heartbeat and dizziness. It is not for people with some kidney, liver, stomach or eye conditions.⁶

Other recent approvals, as of October 2026:

• Bysanti (milsaperidone) was approved on February 20, 2026, for schizophrenia and for manic or mixed episodes in bipolar I disorder.⁷
• Weltruza, a once-monthly olanzapine shot given under the skin, was approved by the FDA on October 9, 2026, for adults with schizophrenia.⁸

New does not always mean better. Ask your doctor whether a newer option fits your health, your other medicines and your budget.

Long-acting injections

Some people find it hard to take a pill every day. Reasons include forgetting, side effects, or not feeling ill. A long-acting injection is a shot that releases medicine slowly. It is given by a health care professional every few weeks or months, so there is no daily pill to remember.^2,9

For example, risperidone comes as shots given every 2 weeks, monthly, or every 2 months, depending on the brand.⁹ Shots are also made with other medicines. Injection-site pain or a lump can happen, and the other side effects are like those of the pill form.⁹

Long-acting injections can be a good choice for a person who wants fewer daily tasks, or for families worried about missed doses. If you miss a shot, see your health care provider as soon as you can.⁹

Clozapine for symptoms that do not improve

Clozapine (Clozaril) is a second-generation antipsychotic with a special role. It is used when symptoms do not improve with the usual antipsychotics.¹ This is sometimes called treatment-resistant schizophrenia. Clozapine is also approved to lower the risk of repeated suicidal behavior in people with schizophrenia or schizoaffective disorder.⁵

Because of a rare but serious risk, people on clozapine need regular blood tests of their white blood cell count. Very low white blood cells (agranulocytosis) raise the chance of serious infection. This happens in fewer than 1 in 100 people, and it goes away when clozapine is stopped.^1,5 One common pattern is weekly tests for the first 6 months, then every 2 weeks, then monthly after the first year. Your care team will tell you the schedule.⁵

Other clozapine risks to know:^5,10

• Heart inflammation (myocarditis), which is rare but can be serious
• Seizures, more likely with fast increases in dose
• Constipation, which can become severe. Tell your doctor early.
• Dizziness or fainting when standing, especially at the start
• Extra drooling, drowsiness and weight gain

If you miss clozapine for more than 2 days, call your doctor before starting again. A lower restart amount may be needed.¹⁰

Side effects and checkups

Antipsychotics can cause side effects. They are not a sign that the medicine is wrong for you, and many can be reduced. Tell your doctor early. There is often another option.¹

In the large review, over about a year, people on an antipsychotic had more movement problems (14% vs 8%), more weight gain (9% vs 6%), and more sleepiness (8% vs 5%) than people on placebo.³ In other words, most people did not have these problems, but some did.

Weight, blood sugar and cholesterol

Many second-generation medicines can raise weight, blood sugar and blood fats. Doctors should check weight, blood sugar and cholesterol on a regular basis.¹ Walking, healthy meals and good sleep can help. If weight or blood sugar climbs, ask whether a change in medicine would help. Tell your doctor about strong thirst or needing to pass urine a lot.

Movement problems and tardive dyskinesia

Antipsychotics can cause stiffness, shaking and restlessness. Tardive dyskinesia (TD) is a different problem. It means uncontrollable movements, often of the face, lips, tongue or limbs. It can range from mild to severe and may develop after long use.^1,11

Two medicines, valbenazine (Ingrezza) and deutetrabenazine (Austedo), were approved in 2017 to treat TD.¹¹ If you think you have TD, check with your doctor before stopping your antipsychotic.¹ Report new movements early, since early action helps.

Other common effects

• Sleepiness or feeling slowed down
• Dizziness when standing, which can cause falls. Stand up slowly.
• Changes in hormones such as prolactin, which can affect periods, breast milk and sex drive⁹
• Heart rhythm changes with some medicines, so your doctor may order a heart tracing (EKG)⁹
• Neuroleptic malignant syndrome, a rare emergency with fever, severe stiff muscles, sweating and confusion. Call 911.⁹

Why stopping suddenly is risky

Many people want to stop. They feel well, the side effects bother them, or they do not feel ill. These are real concerns, and your doctor wants to hear them.

But symptoms often return when medicine stops. In the large review, relapse happened in 24% of people who stayed on an antipsychotic and 61% of people who were switched to placebo. Hospital stays were also less common on medicine, at 7% compared with 18%.³ Those trials mostly lasted up to a year, so longer-term effects are less clear.³

Stopping suddenly can also cause unpleasant or harmful effects. A doctor can lower the amount slowly and safely.¹

If you or someone you love wants to stop, plan it with the doctor and a trusted family member. Watch for early warning signs of relapse and agree on what to do. Our page on helping someone with psychosis covers talking about medicine without arguing.

Medicines in later life

Older adults can be more sensitive to side effects such as dizziness, falls, sleepiness and constipation. Doctors usually start low and go slow. Aging also brings other health problems and medicines that can interact. See psychosis and schizophrenia in later life.

Questions to ask the doctor

The American Psychiatric Association also offers a free guide for patients and families alongside its schizophrenia guideline.¹² Learn more about how schizophrenia is diagnosed, or return to the schizophrenia overview. Some antipsychotics are also used in bipolar disorder; see bipolar medicines.

When to get help

• Call the doctor soon if symptoms are coming back, sleep changes sharply, or side effects trouble you.
• Call the doctor the same day for fever with a sore throat on clozapine, new uncontrolled movements, or severe constipation.
• Call or text 988 any time you or someone you love has thoughts of suicide. It is free and open 24 hours a day. Treatment helps lower the risk of suicide and violence, and many people recover.²
• Call 911 for a seizure, fainting, trouble breathing, fever with stiff muscles and confusion, or when someone is in danger.

You can write a safety plan ahead of time. For more on emergencies, see signs of schizophrenia and when it is an emergency and our help page.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.