Schizophrenia: Medications

Content provided by Healthwise

Medications

Medicines are the primary treatment for managing the symptoms of schizophrenia. But they can sometimes have severe side effects, so regular monitoring is needed.

A combination of several medicines may be the most effective treatment for schizophrenia. But it may take time to determine which medicines will best control your symptoms, and it can be difficult to get through this period. Surrounding yourself with a support system—such as your family or a community-based rehabilitation program—can provide you with the help you need.

Medication Choices

The following medicines are used to treat people with schizophrenia:

• First-generation antipsychotics, such as haloperidol (Haldol), perphenazine (Trilafon), or chlorpromazine (Thorazine), which are used to reduce anxiety and agitation, and to stop delusions and hallucinations. These medicines can be very effective but often have significant side effects, such as tardive dyskinesia, which is a condition that causes uncontrolled body movements.
• Second-generation antipsychotics, such as risperidone (Risperdal), paliperidone (Invega), olanzapine (Zyprexa), ziprasidone (Geodon), and quetiapine (Seroquel). These medicines effectively treat symptoms of schizophrenia and may help reduce the risk for relapse.
  • Clozapine, such as Clozaril or Leponex, is usually considered a second-generation antipsychotic. This drug is approved in the United States for treating suicidal behavior associated with schizophrenia and for severe schizophrenia which has not improved with other treatment. But in the U.S., your doctor will need special authorization to prescribe clozapine for schizophrenia symptoms, and special monitoring is needed when clozapine is used.

A combination of medicines sometimes works best for controlling symptoms of schizophrenia. Other medicines that are often used along with antipsychotic medicines include:¹³

• Lithium carbonate, such as Lithobid, Lithane, and Eskalith, to regulate moods.
• Antianxiety medicines, such as alprazolam (Xanax) and diazepam (for example, Valium), to reduce anxiety and nervousness.
• Anticonvulsant medicines, such as carbamazepine (for example, Tegretol) and valproate (for example, Depakote), to reduce symptoms during relapse.
• Antidepressant medicines, such as selective serotonin reuptake inhibitors (SSRIs) (for example, Zoloft or Celexa) or tricyclic antidepressants (for example, Pamelor), to reduce symptoms of depression that often occur along with schizophrenia.

What To Think About

Second-generation antipsychotics used to treat schizophrenia are usually less likely to cause certain side effects than first-generation antipsychotics. Second-generation antipsychotics may also be more effective in preventing relapse than first-generation medicines.¹⁰ If you have been taking first-generation antipsychotics (such as haloperidol) and have experienced severe or bothersome side effects, talk with your doctor about whether a second-generation antipsychotic may work better for you.

In some cases, first-generation antipsychotics may be as effective as second-generation antipsychotics. One study found perphenazine, an older first-generation antipsychotic, is as effective, as well tolerated, and less expensive than other second-generation antipsychotics.¹⁴

If you stop taking your medicines, you will probably have a relapse. Do not stop taking your medicines until you first talk with your health professional about the risks and benefits.

Some side effects of antipsychotic medicines (such as low blood pressure or tremors) can be serious.

• How to recognize signs of neuroleptic malignant syndrome. The first signs usually include high fever—between and —fast or irregular heartbeat, rapid breathing, and severe sweating.
• How to recognize the first signs of tardive dyskinesia. Some of the first signs may include lip-smacking or continuous chewing; tongue-twitching or thrusting the tongue out of the mouth; or quick, jerky movements (tics) of the head.

Regular blood tests are performed when you are taking antipsychotic medicines to monitor for possible adverse effects of the medicines. Children, teens, and older adults may need to have blood tests more often than other people.

You will need to be closely monitored if the health professional changes or stops your medicines, since this can lead to a relapse. Some people need to be admitted to a hospital while medicines are changed or adjusted. The decision to adjust your medicines is made carefully by you, your entire health care team, and appropriate family members.

Most people with schizophrenia qualify for state-funded health care programs (such as Medicare or Medicaid). To find out whether you qualify, check with your local health and welfare agency.

Taking medicines for schizophrenia during pregnancy may increase the risk of birth defects. If you are pregnant, or thinking of becoming pregnant, talk to your doctor. Medicines may need to be continued at lower doses. Your doctor can help weigh the risks of treatment against the risk of harm to your pregnancy.

Last updated:	February 05, 2008
Author:	Jeannette Curtis
Reviewed By:	Kathleen Romito, MD - Family Medicine, Lisa S. Weinstock, MD - Psychiatry
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC