List of Antipsychotic Drugs | AP Topic Index | Common uses of Antipsychotic Drugs

Like antidepressants (ADs) and anticonvulsants / antiepileptic drugs (AEDs), antipsychotics (APs) are broken up into different classes based upon things like chemical structure and how they work in your brain. Like AEDs there is some overlapping membership. Currently the primary classification of APs is a combination of when they were developed and how they work (pharmacodynamics).

1.  First-Generation Antipsychotic Agents / Neuroleptics

With the exception of lithium carbonate and Haldol (haloperidol), all first-generation antipsychotic agents (FGAs), also known as standard antipsychotics and typical antipsychotics, were thought to work in the exact same way - binding to D2 dopamine, M1 muscarine, H1 histamine, and maybe even a little alpha-1 noradrenergic receptors to interfere with the reception of those neurotransmitters (D2, M1, H1 and α1 antagonists). The only differences being chemical structure, potency at the various receptors, where in your brain this would happen, and each drug’s pharmacokinetics. Haldol is different in that it doesn’t do much as far as M1 and H1 are concerned, and is a lot more potent in binding to alpha-1, so its side effect profile is somewhat different.

With better technology and more competition for grant money, researchers are looking back at FGAs to see how they work. Turns out they all don’t work the same way after all and some (loxapine, chlorprothixene, e.g.) are like Haldol in that they are a lot more like atypical / second-generation antipsychotics than FGAs.

1.1  List of First-Generation / Standard / Typical Antipsychotic Agents

  • Thorazine (chlorpromazine HCl)
  • fluphenazine decanoate
  • Prolixin (fluphenazine HCl)
  • Serentil (mesoridazine besylate)
  • Trilafon (perphenazine)
  • Compazine (prochlorperazine)
  • Mellaril (thioridazine HCl)
  • Stelazine trifluoperazine HCl
  • Haldol (haloperidol)
  • haloperidol decanoate
  • Loxitane (loxapine succinate)
  • Moban (molindone HCl)
  • Orap (pimozide)
  • Navane (thiothixene)
  • Serpasil (reserpine)
  • Taractan / Truxal (chlorprothixene)
  • Sordinol (clopenthixol)
  • Depixol / Fluanxol (flupentixol)
  • flupentixol deconate
  • Clopixol / Acuphase (zuclopenthixol)
  • zuclopenthixol deconate

Subsets of FGAs:

1.2  Phenothiazines1

  • Thorazine (chlorpromazine HCl)
  • fluphenazine decanoate
  • Prolixin (fluphenazine HCl)
  • Serentil (mesoridazine besylate)
  • Trilafon (perphenazine)
  • Compazine (prochlorperazine)
  • Mellaril (thioridazine HCl)
  • Stelazine trifluoperazine HCl

1.3  Thioxanthenes

  • Navane (thiothixene)
  • Taractan / Truxal (chlorprothixene)
  • Sordinol (clopenthixol)
  • Depixol / Fluanxol (flupentixol)
  • flupentixol deconate
  • Clopixol / Acuphase (zuclopenthixol)
  • zuclopenthixol deconate

2.  Second-Generation Antipsychotic Agents / Neuroleptics

Second-generation antipsychotic agents (SGAs), AKA atypical APs (AAPs) do a hell of a lot more than most FGAs. They are broad-spectrum antagonists of dopamine, alpha-noradrenergic, and serotonin receptors. Except for Risperdal (risperidone) and Invega (paliperidone) - which is Risperdal’s active metabolite (i.e. predigested Risperdal) in pill form - no two of them work the exact same way, hence the term “atypical”. Although it’s now unclear if Invega does a little more than Risperdal, or maybe they missed something that Risperdal does. Clozaril (clozapine), Zyprexa (olanzapine) and Saphris (asenapine) are fairly close in pharmacodynamics, and they bind to practically every neurotransmitter receptor you’ve got, while Risperdal / Invega don’t do much more than Haldol (haloperidol) does. Since they are now prescribed far more often than FGAs, the term “atypical” to describe them, and “standard” to describe the older APs, is counterintuitive. So FGA and SGA are the preferred terms among researchers. On most consumer-oriented mental health sites the term “atypical antipsychotic” (AAP) is still used far more often.

2.1  List of Second-Generation / Atypical Antipsychotic Agents

  • Zyprexa (olanzapine)
  • Seroquel (quetiapine)
  • Geodon (ziprasidone)
  • Fanapt (iloperidone)
  • Saphris (asenapine)
  • Risperdal (risperidone)
  • Invega (paliperidone)
  • Latuda (lurasidone)
  • Clozaril (clozapine)
  • Solian (amisulpride)
  • Asendin (amoxapine) - See below

While officially classified as a tetracyclic antidepressant (TCA), Asendin (amoxapine) is being unofficially classified as an SGA by Stahl and other pharmacologists, based upon its efficacy in treating schizophrenia and mechanism of action.

3.  Third-Generation Antipsychotic Agents / Neuroleptics

Third-generation antipsychotic agents (TGAs) are APs that are both dopamine antagonists (interfering with dopamine reception) and partial agonists (stabilizing dopamine reception). Abilify (aripiprazole) is the first TGA on the market, several more are under development / in various clinical trial phases.

4.  Which Is Better, First-Generation / Standard APs or Second-Generation / Atypical APs?

The simple answer: whichever one works for you, and in a perfect world you wouldn’t need an AP in the first place. Generally speaking if an AP is the appropriate drug and your symptoms aren’t particularly complicated, good old Thorazine (chlorpromazine HCl) or Haldol (haloperidol) would probably be the way to go. On the flipside, if you’re so batshit crazy that someone else is reading this page2, then something like Zyprexa, Saphris, or even Clozaril (clozapine) might be needed.
In general AAPs tend to suck less, but that is at such an actuarial level (i.e. from the point of view of insurance companies and HMOs dealing with thousands of people]], there’s no way you can determine which class of med will suck less for you unless you already have a medical history.

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List of Antipsychotic Drugs | AP Topic Index | Common uses of Antipsychotic Drugs

1 This class of meds also includes drugs with the same chemical structure that are not used as antipsychotics. Most phenothiazines can be used to treat intense vomiting. Phenothiazines that aren't classified as antipsychotics are popular as antiemetics in emergency rooms because they help to calm you the hell down.

2 Any way you want to interpret that will work.

Classifications of Antipsychotic Drugs (APs) by Jerod Poore is copyright © 2010
Page created by: Jerod Poore. Date created: 31 December 2010 Last edited by: JerodPoore on 2016–04–18

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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

Author: Date Modified: 2017–03–25 Date Published:

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