What tablets do schizophrenics take? A comprehensive guide to antipsychotic medication

October 7, 2025 •

4 min read

Medication non-adherence among individuals with schizophrenia is a significant challenge, with reported rates ranging widely but averaging around 50%. For many, the cornerstone of treatment involves understanding what tablets do schizophrenics take and adhering to a personalized regimen of antipsychotic medication to manage core symptoms.

Quick Summary

Schizophrenia is primarily treated with antipsychotic tablets, which are categorized into older first-generation and newer second-generation drugs, each with different mechanisms and side effects. These medications, which may include special options like clozapine for treatment-resistant cases, are part of a broader management plan.

Key Points

Two Main Classes: Antipsychotic tablets for schizophrenia are categorized as either first-generation (typical) or second-generation (atypical), which differ in their mechanism of action and side effect profiles.
First-Gen vs. Second-Gen: Typical antipsychotics primarily target dopamine and have a higher risk of movement-related side effects, while atypical drugs affect both dopamine and serotonin with a lower risk of those side effects but a higher risk of metabolic issues.
Clozapine for Resistant Cases: For treatment-resistant schizophrenia, clozapine is the only FDA-approved medication, though it requires strict monitoring due to potential serious side effects.
Adherence is Crucial: Poor medication adherence is a major challenge in schizophrenia treatment, and long-acting injectable (LAI) versions of antipsychotics are an effective alternative to daily tablets for some patients.
Comprehensive Treatment: Medication is just one part of treatment, often supplemented by psychosocial therapies, mood stabilizers, or antidepressants to address co-occurring symptoms.
Personalized Approach: Finding the right medication and dosage is a personalized process that may involve trying different drugs to achieve the best balance of symptom control and tolerability.

The role of antipsychotic medication in schizophrenia

Schizophrenia is a chronic condition characterized by symptoms such as hallucinations, delusions, disorganized thoughts, and reduced emotional expression. While not a cure, antipsychotic tablets are the primary pharmacological treatment used to manage these symptoms and stabilize patients. These medications work by altering the levels of neurotransmitters—brain chemicals—like dopamine and serotonin. By restoring the balance of these chemicals, antipsychotics can help reduce the severity of psychotic symptoms, enabling individuals to engage more fully in their lives and other forms of therapy.

First-generation (typical) antipsychotics

First-generation antipsychotics, also known as typical or conventional antipsychotics, are an older class of medications first developed in the 1950s. They primarily work by blocking dopamine receptors in the brain, which is effective at controlling the positive symptoms of schizophrenia, such as hallucinations and delusions. However, this mechanism can also lead to a higher risk of movement-related side effects, often termed extrapyramidal symptoms (EPS).

Commonly prescribed first-generation tablets include:

Haloperidol (Haldol)
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
Perphenazine (Trilafon)
Trifluoperazine (Stelazine)

Second-generation (atypical) antipsychotics

Second-generation antipsychotics, or atypical antipsychotics, are newer medications that are more commonly prescribed today. They act on both dopamine and serotonin receptors, which results in a lower risk of extrapyramidal side effects compared to their first-generation counterparts. Atypical antipsychotics are often effective for managing both positive and negative symptoms of schizophrenia, with negative symptoms referring to a reduction in typical functions like motivation and emotional expression.

Examples of second-generation tablets include:

Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Aripiprazole (Abilify)
Lurasidone (Latuda)
Clozapine (Clozaril, Versacloz)
Ziprasidone (Geodon)

Tablets for treatment-resistant schizophrenia

For individuals who do not respond adequately to at least two different antipsychotic medications, the condition is considered treatment-resistant. In these cases, one specific tablet stands out: clozapine. Clozapine was the first atypical antipsychotic and is the only FDA-approved medication for this condition. It is highly effective but requires regular blood monitoring due to a small risk of a severe side effect called agranulocytosis, which affects white blood cells. Despite this, it can be life-changing for patients with treatment-resistant schizophrenia, significantly reducing symptoms and hospitalization risk.

Long-acting injectable (LAI) antipsychotics

While the focus is often on tablets, it is important to mention long-acting injectable (LAI) antipsychotics, which are administered by a healthcare professional every few weeks or months. LAIs are particularly beneficial for individuals who struggle with adherence to a daily oral medication regimen. By providing a slow, steady release of medication, LAIs can ensure consistent therapeutic levels in the body, which helps prevent relapses. Many first- and second-generation antipsychotics are available in LAI form, offering an alternative for those who find daily tablets difficult to manage.

Other medications used in schizophrenia treatment

Antipsychotic tablets are the foundation, but a treatment plan can be complex and may include other medications to address co-occurring symptoms. These may include:

Antidepressants: To manage symptoms of depression, which can co-occur with schizophrenia. Selective serotonin reuptake inhibitors (SSRIs) are a common choice.
Mood stabilizers: Used to help regulate mood-related symptoms, such as those associated with bipolar disorder, which sometimes overlaps with schizophrenia. Examples include lithium or valproate.
Anti-anxiety drugs: For managing anxiety or agitation, typically for a short duration. Benzodiazepines like lorazepam may be used.
Medications for side effects: If extrapyramidal symptoms occur from first-generation antipsychotics, drugs like benztropine may be prescribed.

Comparison of antipsychotic medication classes


Feature	First-Generation (Typical)	Second-Generation (Atypical)
Mechanism of Action	Primarily blocks dopamine D2 receptors.	Blocks both dopamine D2 and serotonin 5-HT2A receptors.
Symptom Focus	Most effective for positive symptoms (hallucinations, delusions).	Effective for both positive and negative symptoms.
Movement-Related Side Effects	Higher risk, including extrapyramidal symptoms and tardive dyskinesia.	Lower risk of extrapyramidal symptoms.
Metabolic Side Effects	Generally lower risk of weight gain, diabetes, and high cholesterol.	Higher risk of weight gain, diabetes, and metabolic syndrome.
Common Tablets	Haloperidol, Chlorpromazine.	Risperidone, Olanzapine, Quetiapine.
Preferred Use	Sometimes used for cost-effectiveness or specific symptoms.	Typically used as a first-line treatment due to a more favorable side effect profile.

The importance of personalized treatment and adherence

Finding the right medication and dosage is a personalized process that requires close collaboration with a healthcare provider. It's not uncommon to try different antipsychotic tablets before finding one that effectively manages symptoms with tolerable side effects. Consistent medication adherence is critical for preventing relapses and hospitalizations, and strategies like LAI options or simple reminder systems can help individuals stay on track. Beyond tablets, a comprehensive treatment plan also includes psychosocial therapies, support systems, and a focus on overall physical health.

Conclusion

For those asking "what tablets do schizophrenics take?", the answer involves a wide range of medications, most commonly falling into first- or second-generation antipsychotic classes. These treatments, including specialized options like clozapine for treatment-resistant cases, are designed to alleviate psychotic symptoms and stabilize brain chemistry. Effective management of schizophrenia is a long-term commitment that balances medication benefits against potential side effects, often with the aid of other therapies and support. By working closely with a healthcare team, individuals can find the optimal combination of medication and support to achieve better outcomes and improved quality of life. Mind.org.uk offers additional resources on antipsychotic medication and support for individuals with psychosis.

Frequently Asked Questions

First-generation, or typical, antipsychotics are older medications that primarily block dopamine receptors. Second-generation, or atypical, antipsychotics are newer and affect both dopamine and serotonin, generally resulting in fewer movement-related side effects.

Not necessarily. While they typically have a better side effect profile regarding movement disorders, second-generation antipsychotics carry a higher risk of metabolic side effects, such as weight gain and high blood sugar. The best medication depends on the individual's symptoms and tolerance.

Clozapine is a powerful second-generation antipsychotic reserved for individuals with treatment-resistant schizophrenia—meaning their symptoms did not improve on at least two other medications. It is also used for those at high risk for suicide or aggressive behavior.

Regular blood monitoring is necessary for individuals taking clozapine because of a rare but serious side effect called agranulocytosis, which is a dangerous drop in the white blood cell count.

While antipsychotic medication is considered the standard of care and is highly effective in managing symptoms and preventing relapses, the decision to take medication should be made in consultation with a healthcare provider. Treatment plans are individualized and may include other therapies.

Abruptly stopping antipsychotic medication can significantly increase the risk of a relapse of psychotic symptoms, such as hallucinations and delusions. This can lead to more severe episodes and potential re-hospitalization.

LAI antipsychotics are injected every few weeks or months instead of being taken as a daily tablet. They are an effective option for individuals who struggle with remembering to take oral medication regularly and can improve treatment adherence.