Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
3 drugs selected — Clozapine, Olanzapine, Risperidone(click to collapse)
3/4 selected
Clozapine
Clozaril
Second-Generation Antipsychotic
FDA-approved indications
- Treatment-resistant schizophrenia (failure of standard antipsychotic treatment)
- Reducing risk of recurrent suicidal behavior in schizophrenia/schizoaffective disorder
Off-label uses
- Bipolar disorder (treatment-resistant)
- Psychosis in Parkinson's disease
- Aggression in intellectual disability
MechanismAtypical Antipsychotic
Half-life12 hours
Olanzapine
Zyprexa
Second-Generation Antipsychotic
FDA-approved indications
- Schizophrenia (adults; adolescents 13–17 years)
- Acute manic or mixed episodes in Bipolar I — mono or adjunct with lithium/valproate
- Bipolar I maintenance (adults)
- Treatment-resistant depression — combination with fluoxetine (adults)
Off-label uses
- Anorexia nervosa
- Chemotherapy-induced nausea
- Delirium
MechanismAtypical Antipsychotic
Half-life21 to 54 hours
Risperidone
Risperdal
Second-Generation Antipsychotic
FDA-approved indications
- Schizophrenia (adults; adolescents 13–17 years)
- Acute manic or mixed episodes in Bipolar I — mono or adjunct with lithium/valproate
- Irritability associated with autistic disorder (5–16 years)
Off-label uses
- PTSD
- OCD augmentation
- Agitation in dementia
MechanismAtypical Antipsychotic
Half-life3 hours (9-OH-risperidone: 21 hours)
Decision GuideWhen to pick each / when to consider an alternative
Clozapine
Consider when
- Treatment-resistant schizophrenia — only antipsychotic with level-1 evidence for TRS; guideline-mandated after two adequate trials
- Suicidality in schizophrenia/schizoaffective — unique FDA indication for suicide risk reduction (InterSePT trial)
- EPS intolerance from prior agents — lowest akathisia and parkinsonism risk; near-zero TD incidence
- Failed two adequate antipsychotic trials — discontinuation worsens outcomes; long-term retention superior to all other SGAs
- +1 more
Consider an alternative when
- Cannot commit to ANC monitoring — REMS-required weekly initially, then biweekly/monthly; non-negotiable
- Active myocarditis or cardiomyopathy history — labeled myocarditis warning; potentially fatal; highest cardiotoxicity among SGAs
- Prior clozapine-induced agranulocytosis — contraindicated for rechallenge after severe neutropenia (ANC <500)
- Severe constipation or GI hypomotility risk — life-threatening ileus and bowel necrosis; GI monitoring required
- +1 more
Olanzapine
Consider when
- Acute agitation requiring rapid control — IM olanzapine for acute agitation; fastest onset among SGA IM formulations
- EPS-free profile critical — near-placebo akathisia (RR 0.99) and antiparkinson use (RR 1.02); avoids motor side effects
- Treatment-resistant depression adjunct — FDA-approved as Symbyax (olanzapine/fluoxetine) for TRD and bipolar depression
- Bipolar mania or maintenance — strong efficacy signal in Huhn 2019 NMA; FDA-approved for acute mania and maintenance
- +1 more
Consider an alternative when
- Cardiometabolic risk — class-top weight gain among non-clozapine SGAs (+3.82 kg Burschinski 2023); diabetes risk OR 1.67
- First-episode psychosis where metabolic baseline is preservable — early metabolic damage is poorly reversible; aripiprazole preferred
- BMI ≥25 or rapid weight gain history — labeled 30%+ weight gain ≥7% of body weight; appetite stimulation is near-universal
- Daytime sedation poorly tolerated — high H1 antagonism; dose-dependent somnolence limits functional recovery
- +1 more
Risperidone
Consider when
- Pediatric autism irritability (5–16 years) — one of only two SGAs with FDA approval; most extensive pediatric data in autism
- Generic access and broad formulary coverage needed — well-established with extensive long-term outcome data
- LAI for non-adherent patient — biweekly Risperdal Consta; SQ Perseris monthly; established LAI track record
- Prolactin monitoring feasible — therapeutic window 28–112 ng/mL enables plasma-level-guided dosing
- +1 more
Consider an alternative when
- Hyperprolactinemia concern — class-near-top prolactin elevation; galactorrhea, amenorrhea, sexual dysfunction, osteoporosis risk
- Elderly patient with dementia — boxed warning for cerebrovascular events; risperidone specifically studied and flagged
- EPS-vulnerable patient — dose-dependent EPS; parkinsonism and TD risk higher than most newer SGAs
- Cardiometabolic risk patient — second-tier weight gain (~2 kg short-term); worse metabolic profile than aripiprazole/ziprasidone
- +1 more
Drug-Drug Interactions2 major1 moderate
Educational reference only. Interactions are extracted from FDA prescribing information and DDInter 2.0. Always verify with institutional pharmacy systems before clinical decisions.
Efficacy & Acceptability (2 axes)— NMA efficacy & discontinuation data (not side effects)
| Axis | Clozapine | Olanzapine | Risperidone |
|---|---|---|---|
| 📊 Efficacy (response rates) | |||
SchizophreniaEfficacy | |||
| 🛡️ Acceptability (all-cause discontinuation) | |||
SchizophreniaAcceptability | — | ||
| Axis | Clozapine SGA | Olanzapine SGA | Risperidone SGA |
|---|---|---|---|
| Boxed Warnings | |||
Suicidality (boxed warning) | — | — | |
Agranulocytosis / severe neutropenia | — | ||
Myocarditis / cardiomyopathy (boxed warning) | — | — | |
Cerebrovascular events (elderly w/ dementia) | |||
Neuroleptic malignant syndrome (NMS) | — | ||
DRESS / multiorgan hypersensitivity | — | — | |
| CNS | |||
Sedation / somnolence | |||
Activation / insomnia | |||
Akathisia / EPS | |||
Tardive dyskinesia | — | — | |
Seizure risk | |||
| Metabolic | |||
Weight gain | |||
Metabolic (glucose / lipids) | |||
| Endocrine | |||
Prolactin elevation | |||
| Autonomic | |||
Anticholinergic burden | |||
Orthostatic hypotension | |||
Sweating | — | — | |
Sialorrhea / hypersalivation | — | — | |
| Cardiac | |||
QTc prolongation | |||
Heart rate / tachycardia | — | ||
| GI | |||
Nausea / GI (general) | |||
Constipation / GI hypomotility | — | — | |
| Hepatic | |||
Liver enzymes / hepatotoxicity | — | ||
| Sexual | |||
Sexual dysfunction | |||
| GU | |||
Priapism | — | — | |
| Discontinuation | |||
Withdrawal / discontinuation | — | ||
| Interactions | |||
CYP interactions / DDI profile | |||
| Pregnancy | |||
Teratogenicity | — | ||
Lactation / breastfeeding safety | |||