Fast Five Quiz: Schizophrenia Management in Adults

Stephen Soreff, MD


August 11, 2020

There is no clear antipsychotic drug of choice for schizophrenia. Clozapine is the most effective medication but is not recommended as first-line therapy because it has a high burden of adverse effects, requires regular bloodwork, and has not outperformed other medications in patients with a first episode.

Olanzapine is a selective monoaminergic antagonist at serotonin, dopamine D1-4, muscarinic, histamine H1, and alpha-1–adrenergic receptors. It is available as a regular tablet, a rapidly disintegrating tablet, a short-acting injectable solution, and a long-acting injectable formulation. The most common side effects of olanzapine include weight gain, sedation, akathisia, hypotension, dry mouth, and constipation.

Haloperidol is a dopamine D2 antagonist noted for high potency and low potential for causing orthostasis. The drawback is the high potential for extrapyramidal symptoms or dystonia. Haloperidol can interact with CYP3A4 and CYP2D6 inhibitors and inducers. It also can interact with drugs that prolong QTc intervals. Haloperidol is available in tablets, as a liquid concentrate, in IM and intravenous forms, and in long-acting IM form for depot injection.

Learn more about schizophrenia medication.


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