The previous NICE guidelines recommended atypical antipsychotic drugs as first-line therapy. However, studies have shown that there is little meaningful difference in efficacy between typical and atypical antipsychotic drugs (other than clozapine), and the response and tolerability to each drug varies significantly between patients. Therefore, there is no apparent first-line antipsychotic drug that is offered for all patients with schizophrenia.

The main advantage of atypical antipsychotic drugs in comparison to typical antipsychotics is the reduced tendency to cause extrapyramidal side effects. However, this should be balanced against various other side effects, such as weight gain and metabolic syndrome which can increase the risk of cardiovascular disease and diabetes.

Furthermore, emphasis has been placed that the choice of antipsychotic and formulation should be based on an informed discussion and made in participation with the patient and/or carer. The aim of the treatment for patients with schizophrenia is to find an antipsychotic drug that provides the most suitable balance of efficacy and tolerability to improve adherence and prevent relapse.

 

The choice of treatment should consider:
• Patient’s clinical presentation
• Side effect profile (EPS, metabolic syndrome, weight gain, etc)
• Patient’s history of medication adherence
• Any patient comorbidities (such as diabetes or kidney disease) or other physical considerations (such as obesity)
• Possible interactions with any concomitant medicines
• Patient’s response to previous treatments
• Views of the patient’s and carers.

The side effects of antipsychotic's can be identified and monitored using self-rated side effect rating scales such as the “Glasgow antipsychotic side effect scale” (GASS) or the “Liverpool University neuroleptic side effect ratings scale” (LUNSERS).



The link below provides an example of how patients can chose an appropriate antipsychotic drug by taking into consideration the side effects caused. 



The Maudsley Hospital- Information about antipsychotic medication.