4.2.1 Antipsychotic drugs

Psychoses and schizophrenia

Prescribing should only be commenced after seeking specialist advice, except in circumstances where prescribers feel confident to prescribe e.g. an existing patient suffering a recurrent acute episode previously managed on antipsychotic treatment.

Where a specialist opinion has been sought, GP’s will be asked to continue prescribing and monitor the physical health of the patient, where appropriate

NICE CG178 - Psychosis and schizophrenia in adults

Further information can be found at: SPfT: Guidance on the use of antipsychotics

 Atypical Antipsychotics: metabolic effects

Some second-generation antipsychotics are associated with metabolic adverse effects, namely significant weight gain (>7% of baseline), dyslipidaemia, and hyperglycaemia. Atypical antipsychotics vary in the extent to which they cause metabolic adverse effects but clozapine, olanzapine, and quetiapine are especially implicated.

Atypical Antipsychotics: Stroke

Antipsychotics are associated with an increased risk of cerebrovascular adverse events and greater mortality when used in patients with dementia.

Use of antipsychotics should be avoided except in cases of severe distress or if there is an immediate risk of harm to the person or others.

DO NOT USE antipsychotics in Lewy Body dementia or Parkinson’s disease dementia.For information on short term use of risperidone in dementia.  See the Dementia Prescribing Support document for GPs

Choice of Antipsychotic

All antipsychotics should be initiated by a specialist when used to treat psychosis and schizophrenia. Information on suitable choices can be found here.


Clozapine must be prescribed by mental health specialists only.  ALL patients must be registered with a Clozapine monitoring service.

100 tablet
100 tablet

Lurasidone has been approved for use in the following situations:

  • THIRD LINE use after two previous antipsychotics (of which one must be Aripiprazole) have been tried and at least one was effective but not tolerated. 
  • SECOND LINE use in patients identified as having significant metabolic risk factors e.g. diabetes, obesity provided Aripiprazole has been tried first and has been found ineffective or not tolerated.
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28 tablet
28 tablet
  • First Line Drugs
  • Second Line Drugs
  • Specialist Initiated Drugs with Shared Care Guidelines
  • Specialist Only Drugs
  • Mixed Status