Antipsychotic Drugs: Summary of affordable alternatives
Antipsychotic drugs help many people with schizophrenia live more meaningful, stable lives with fewer — and sometimes no — periods of hospitalization. But they are a highly problematic class of medicines. A sizeable percentage of people with schizophrenia get little or no benefit when they take an antipsychotic while others get only a partial reduction in symptoms. Side effects pose a major barrier to continuous use. In studies, for example, three of every four people stopped taking an antipsychotic or switched to a different one within 18 months.
Newer and quite expensive antipsychotics marketed heavily to doctors over the past 15 years have largely eclipsed an older generation of drugs developed in the 1950s and 1960s. Research for years appeared to indicate that the newer drugs were better, largely because they had fewer side effects. But recent large-scale studies now indicate that, overall, the older drugs work just as well, at far lower cost.Taking effectiveness, safety, side effects, patient variability, dosing convenience, and cost into account, we have chosen the following as Consumer Reports Best Buy Drugs:
- Generic perphenazine — as initial treatment for people newly diagnosed with schizophrenia and for people with schizophrenia who have failed on a newer drug and whose doctor thinks perphenazine is worth a try. Patients taking perphenazine should be monitored closely for muscle tremors and spasms.
- Olanzapine (Zyprexa) — for certain people with schizophrenia who take perphenazine first and get no or minimal benefit and/or experience intolerable side effects. Zyprexa is not a good option, however, for people who are overweight, have blood sugar abnormalities, diabetes, or heart disease.
- Risperidone (Risperdal) — for people with schizophrenia who take perphenazine first and get minimal benefit and/or experience intolerable side effects.
- Generic clozapine — for people with moderate to severe schizophrenia who have not responded at all to two or more other antipsychotics and have had little reduction in symptoms.
The choice of generic perphenazine — if a patient responds well to it — saves about $200 to $500 a month ($2,400 to $6,000 a year) compared to Zyprexa and Risperdal, depending on the dose required.
We make no choice of a Best Buy antipsychotic for people with bipolar disorder. There is not enough evidence to do so.
Antipsychotic Drugs: Cost Comparison and Best Buy Drugs
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| Recommendations: Antihistamine Drugs | ||||||
| CR Best Buy | Generic Name and Dose | Brand Name1 | Frequency of Use Per Day2 | Total Daily Dose | Average Monthly Cost3 | Compare Prices |
| Aripiprazole 10mg tablet | Abilify | One | 10mg | $481 |  |
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| Aripiprazole 15mg tablet | Abilify | One | 15mg | $469 | |
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| Aripiprazole 20mg tablet | Abilify | One | 20mg | $661 | |
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| Aripiprazole 30mg tablet | Abilify | One | 30mg | $657 | |
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| Chlorpromazine 25mg tablet | Generic | One-Three | 25mg-75mg | $14-$42 | |
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| Chlorpromazine 50mg tablet | Generic | One-Three | 50mg-150mg | $17-$51 | |
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| Chlorpromazine 100mg tablet | Generic | One-Three | 100mg-300mg | $21-$63 | |
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| Chlorpromazine 200mg tablet | Generic | One-Three | 200mg-600mg | $25-$75 | |
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Clozapine 25mg tablet | Generic | One-Three | 25mg-75mg | $37-$111 | |
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Clozapine 50mg tablet | Generic | One-Three | 50mg-150mg | $65-$195 | |
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Clozapine 100mg tablet | Generic | One-Three | 100mg-300mg | $172-516 | |
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Clozapine 25mg dissolvable tablet | Fazaclo | One-Three | 25mg-75mg | $52-156 | |
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Clozapine 100mg dissolvable tablet | Fazaclo | One-Three | 100mg-300mg | $127-$381 | |
| Haloperidol 0.5mg tablet | Generic | Three | 1.5mg | $27 | |
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| Haloperidol 1mg tablet | Generic | Two-Three | 2mg-3mg | $21-$32 | |
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| Haloperidol 2mg tablet | Generic | Two-Three | 4mg-6mg | $27-$41 | |
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| Haloperidol 5mg tablet | Generic | One-Three | 5mg-15mg | $21-$62 | |
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| Haloperidol 10mg tablet | Generic | One-Two | 10mg-20mg | $38-$76 | |
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| Loxapine 10mg capsule | Generic | Two-Three | 20mg-30mg | $72-$108 | |
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| Loxapine 25mg capsule | Generic | One-Three | 25mg-75mg | $50-$150 | |
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| Loxapine 50mg capsule | Generic | One-Three | 50mg-150mg | $70-$210 | |
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Olanzapine 5mg tablet | Zyprexa | One | 5mg | $275 | |
| Olanzapine 5mg dissolvable tablet | Zyprexa Zydis | One | 5mg | $327 | |
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Olanzapine 7.5mg tablet | Zyprexa | One | 7.5mg | $338 | |
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Olanzapine 10mg tablet | Zyprexa | One | 10mg | $418 | |
| Olanzapine 10mg dissolvable tablet | Zyprexa Zydis | One | 10mg | $494 | |
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Olanzapine 15mg tablet | Zyprexa | One | 15mg | $629 | |
| Olanzapine 15mg dissolvable tablet | Zyprexa Zydis | One | 15mg | $637 | |
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Olanzapine 20mg tablet | Zyprexa | One | 20mg | $866 | |
| Olanzapine 20mg dissolvable tablet | Zyprexa Zydis | One | 20mg | $868 | |
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| Molindone 10mg tablet | Moban | Two-Three | 20mg-30mg | $154-$231 | |
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| Molindone 25mg tablet | Moban | One-Three | 25mg-75mg | $105-$315 | |
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| Molindone 50mg tablet | Moban | One-Three | 50mg-150mg | $153-$459 | |
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Perphenazine 2mg tablet | Generic | Four | 8mg | $68 | |
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Perphenazine 4mg tablet | Generic | Two-Four | 8mg-16mg | $48-$96 | |
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Perphenazine 8mg tablet | Generic | Two-Four | 16mg-32mg | $56-$112 | |
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Perphenazine 16mg tablet | Generic | One-Two | 16mg-32mg | $39-$78 | |
| Quetiapine 25mg tablet | Seroquel | Two | 50mg | $152 | |
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| Quetiapine 50mg tablet | Seroquel | Two | 100mg | $256 | |
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| Quetiapine 100mg tablet | Seroquel | Two | 200mg | $266 | |
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| Quetiapine 200mg tablet | Seroquel | Two | 400mg | $502 | |
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| Quetiapine 300mg tablet | Seroquel | Two | 600mg | $662 | |
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| Quetiapine 400mg tablet | Seroquel | Two | 800mg | $782 | |
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Risperidone 0.25mg tablet | Risperdal | Two | 0.50mg | $276 | |
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Risperidone 0.5mg tablet | Risperdal | Two | 1mg | $298 | |
| Risperidone 0.5mg dissolvable tablet | Risperdal | Two | 1mg | $336 | |
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Risperidone 1mg tablet | Risperdal | Two | 2mg | $318 | |
| Risperidone 1mg dissolvable tablet | Risperdal | Two | 2mg | $396 | |
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Risperidone 2mg tablet | Risperdal | Two | 4mg | $520 | |
| Risperidone 2mg dissolvable tablet | Risperdal | Two | 4mg | $638 | |
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Risperidone 3mg tablet | Risperdal | One-Two | 3mg-6mg | $303-$606 | |
| Risperidone 3mg dissolvable tablet | Risperdal | One-Two | 3mg-6mg | $387-$774 | |
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Risperidone 4mg tablet | Risperdal | One | 4mg | $405 | |
| Risperidone 4mg dissolvable tablet | Risperdal | One | 4mg | $500 | |
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| Thiothixene 2mg capsule | Generic | Two-Three | 2mg-6mg | $22-$33 | |
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| Thiothixene 5mg capsule | Generic | One-Three | 5mg-15mg | $15-$45 | |
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| Thiothixene 10mg capsule | Generic | One-Three | 10mg-30mg | $17-$51 | |
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| Trifluoperazine 2mg | Generic | One-Three | 2mg-6mg | $19-$57 | |
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| Trifluoperazine 5mg | Generic | One-Three | 5mg-15mg | $22-$66 | |
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| Trifluoperazine 10mg | Generic | One-Two | 10mg-20mg | $34-$68 | |
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| Ziprasidone 20mg capsule | Geodon | Two | 40mg | $386 | |
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| Ziprasidone 40mg capsule | Geodon | Two | 80mg | $398 | |
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| Ziprasidone 60mg capsule | Geodon | Two | 120mg | $406 | |
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| Ziprasidone 80mg capsule | Geodon | Two | 160mg | $408 | |
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1. For the first-generation drugs – whose names are listed in italics – only the monthly costs of the generics are given, except for molindone (Moban); no generic of Moban is yet available. Over 90 percent of the prescriptions for these drugs are generic. For clozapine, only the generic prices are given for the oral, non-dissolvable tablet form.
2. Dose range recommendations for the second-generation antipsychotics are derived from the American Psychiatric Association Schizophrenia Reference Guide and The Medical Letter – Treatment Guidelines for Antipsychotic Drugs (June 2006, Issue 46). Dose ranges for the first-generation drugs are from Consumer Reports Consumer Drug Reference (2006 Edition) and The Medical Letter – Treatment Guidelines for Antipsychotic Drugs (June 2006, Issue 46). All the antipsychotics are prescribed in a wide range of doses to meet patients’ individual needs. Most people are started on low doses to gauge their response and experience of side effects. The dose is then usually increased, sometimes substantially.
3. Prices reflect nationwide retail averages for September 2006; rounded to the nearest dollar. Information derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Health, Pharmaceutical Audit Suite.
2. Dose range recommendations for the second-generation antipsychotics are derived from the American Psychiatric Association Schizophrenia Reference Guide and The Medical Letter – Treatment Guidelines for Antipsychotic Drugs (June 2006, Issue 46). Dose ranges for the first-generation drugs are from Consumer Reports Consumer Drug Reference (2006 Edition) and The Medical Letter – Treatment Guidelines for Antipsychotic Drugs (June 2006, Issue 46). All the antipsychotics are prescribed in a wide range of doses to meet patients’ individual needs. Most people are started on low doses to gauge their response and experience of side effects. The dose is then usually increased, sometimes substantially.
3. Prices reflect nationwide retail averages for September 2006; rounded to the nearest dollar. Information derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Health, Pharmaceutical Audit Suite.
