Over the past few years several newer generation antipsychotic medications with weak dopaminergic activity similar to clozapine, have been developed (olanzapine, quetiapine, ziprasidone and aripiprazole, paliperidone). Risperidone with dopaminergic activity intermediate between chlorpromazine and clozapine has also gained wide popularity. These drugs should cause less EPS and be less likely to cause tardive dyskinesia. They may also be more effective in treating the negative symptoms of schizophrenia. The lack of severe hematolgic effects makes them superior to clozapine for initial therapy. Most psychiatrist have adopted their use for first-line management.However the CATIE study (Lieberman et al: 2005] suggests that there is still a roll for older generation drugs.
The cost of newer generation antipsychotics is prohibitive for most patients if they aren’t covered by a third party payer. Even with insurance coverage, some payers may restrict their formulary to only one or two of the newer generation drugs. Therefore, ability to pay should be a significant consideration in determining which medication to use.