7 Key Facts About Atypical Antipsychotics You Should Know

Atypical antipsychotics are medications that treat many mental health conditions, including schizophrenia, bipolar disorder, and more. They’re part of a broader group of medications called “antipsychotics.” Typical antipsychotics are also included in this broad group. Typical and atypical antipsychotics treat many of the same medical conditions. But they have many differences in how they work and what side effects they can cause.

If you take an atypical antipsychotic, you’ll want to know how they work, what side effects they can cause, and why stopping them abruptly isn’t a good idea.

What are atypical antipsychotics?

Atypical antipsychotics are a group of medications that treat many mental health conditions. They’re also called “second-generation” antipsychotics. Some examples include:

• Quetiapine (Seroquel)

• Aripiprazole (Abilify)

• Risperidone (Risperdal)

• Olanzapine (Zyprexa)

• Lurasidone (Latuda)

• Ziprasidone (Geodon)

• Clozapine (Clozaril)

• Iloperidone (Fanapt)

All atypical antipsychotics aren’t FDA approved to treat the same medical conditions. But many of them are approved to treat health conditions, like schizophrenia and bipolar disorder

How do atypical antipsychotics work?

Atypical antipsychotics work by changing the balance of certain chemicals in the brain. This includes blocking dopamine activity. Dopamine is often called the “happy hormone.” It helps create feelings of pleasure. But in certain mental health conditions, dopamine levels are unbalanced. Too much dopamine in some areas of the brain, and too little dopamine in other areas, can lead to symptoms of schizophrenia. This includes hallucinations and delusions (belief in things that aren’t a reality for other people).

Atypical antipsychotics also work by balancing serotonin activity. Serotonin is a chemical that helps regulate your mood. Atypical antipsychotics make serotonin less active overall. This has been shown to decrease symptoms like psychosis (a disconnect from reality).

These medications also affect other chemicals in your body, including histamine and acetylcholine. This is likely the cause of many common side effects of these medications. Examples include dry mouth, constipation, and drowsiness.

7 things you should know about atypical antipsychotics

The individual atypical antipsychotics share many similarities. But there are also many differences. Let's dive into seven key facts you should know about this diverse group of medications.

1. Atypical antipsychotics come in many forms

Atypical antipsychotics come in a variety of formulations. This gives you many different options to choose from if you’re prescribed one of these medications.

Read more like this

Explore these related articles, suggested for readers like you.

What’s the Difference Between Typical vs. Atypical Antipsychotics?

6 Medications That May Cause Tardive Dyskinesia

What Is It Like to Have Tardive Dyskinesia?

Alcohol, Paxlovid, and More: 14 Quetiapine (Seroquel) Interactions to Watch Out For

View more

For example, aripiprazole comes as a tablet, orally disintegrating tablet (ODT), and oral solution. It also comes as a tablet and device combination that tracks if you’ve taken your medication (Abilify MyCite). Lastly, it comes as an intramuscular (IM) injection that’s given into a muscle (Abilify Maintena and Aristada). And olanzapine comes as a tablet, ODT (Zyprexa Zydis) and IM injection (Zyprexa Relprevv).

Some of these formulations work longer than others. Some IM injections only need to be given once a month or longer because their effects can last that long. Some people might prefer injections over pills because you don’t have to remember to take them daily. On the other hand, many injections have to be given in your healthcare provider’s office. Some people may not be able to make it to their provider’s office routinely, so a pill might be preferable.

2. It can take time to find the best atypical antipsychotic for you

Not all atypical antipsychotics work the exact same way. They all have some effect on dopamine or serotonin. But each atypical antipsychotic affects these chemicals (and others) to varying degrees.

It can take time for you and your healthcare provider to find the right medication for you. You may need to try more than one before finding the right one. The best option is usually the one that's the most effective, causes the least side effects, and takes your personal preferences into account.

3. Atypical antipsychotics can have some common side effects

All atypical antipsychotics can cause side effects. But some may be more likely than others to cause certain ones. This is because each atypical antipsychotic has varying effects on different chemicals in the body.

The table below details a few of the most common atypical antipsychotic side effects — and which individual medications are most likely to cause them.

Even if the atypical antipsychotic you’re taking isn’t the most likely to cause a certain side effect, it can still happen. So if you experience any of these side effects at any point, talk to your healthcare provider. They can help you choose another atypical antipsychotic that may be less likely to cause the side effect you’re experiencing.

4. Atypical antipsychotics can have more serious side effects, but they’re rare

Serious side effects of atypical antipsychotics are rare. But they’re possible. Some serious side effects include:

• Increased risk of death in older adults with dementia-related psychosis

• Heart muscle inflammation (myocarditis)

• Neuroleptic malignant syndrome

• Dangerous heart rhythms (arrhythmias)

• Low white blood cell counts (the cells that help fight infection)

• Risk of suicidal thoughts or behavior

Certain atypical antipsychotics may be more likely to cause these serious side effects. For example, clozapine is most likely to cause a severely low white blood cell count. It has a special monitoring program called a Risk Evaluation and Mitigation Strategy (REMS) to help lower this risk. 

Less often, atypical antipsychotics may cause a side effect known as extrapyramidal symptoms. These are uncontrollable body movements. But it’s not as common with these medications as it is with typical antipsychotics.

If you or someone you know is struggling with self-harm, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line. 

5. Atypical antipsychotics can have drug interactions

Atypical antipsychotics may have drug interactions. These interactions can vary depending on the atypical antipsychotic you take. 

For example, some antipsychotics are known to interact with certain antibiotics. This includes macrolides, like azithromycin (Zithromax), and fluoroquinolones, like ciprofloxacin (Cipro). They may also interact with some anti-seizure medications, like carbamazepine (Tegretol) and phenytoin (Dilantin, Phenytek). 

Keep an updated medication list that includes all the medications and supplements you take. This list should include prescription and over-the-counter products. Share it with your healthcare provider and pharmacist so they can check for interactions. And if you use any tobacco products or consume grapefruit or grapefruit juice, let them know. Tobacco may lower the effectiveness of certain antipsychotic medications. And grapefruit may increase the risk of side effects.

6. Don’t stop atypical antipsychotics abruptly

You shouldn’t stop taking an atypical antipsychotic without talking to your healthcare provider first. This can lead to withdrawal symptoms. This might include nausea and vomiting, movement issues, and restlessness.

Besides withdrawal symptoms, stopping these medications can worsen your medical condition. Symptoms like hallucinations, delusions, and psychosis may return or worsen.

Stopping an atypical antipsychotic usually involves lowering your dose over weeks or months. If you want to stop your atypical antipsychotic, or switch to another one, talk to your provider about the best and safest way to do this.

7. Some people shouldn’t use atypical antipsychotics

Antipsychotics shouldn’t be used in certain cases. Examples of situations where atypical antipsychotics shouldn’t be used include people living with:

• Severe types of extrapyramidal symptoms, like tardive dyskinesia or parkinsonism

• Previous neuroleptic malignant syndrome

• Glaucoma

• Liver disease

• Severely low white blood cell counts

• Bone marrow disease

Atypical antipsychotics also shouldn’t be used in older adults with dementia. In fact, there’s a boxed warning for this. This is the strictest warning that the FDA assigns to a medication. The use of atypical antipsychotics is linked to an increased risk of death in this group of people.

Why trust our experts?

Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She currently practices as a clinical pharmacist at Buffalo General Medical Center.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Our editorial standards

Meet our experts