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
1 drug selected — Iloperidone(click to collapse)
1/4 selected
Iloperidone
Fanapt
Second-Generation Antipsychotic (SGA)
FDA-approved indications
- Schizophrenia in adults
- Acute bipolar I mania/mixed episodes in adults
Off-label uses
- Psychosis refractory to other antipsychotics
- PTSD-related nightmares (theoretical — potent alpha-1 blockade, analogous to prazosin mechanism)
- Bipolar depression (not FDA-approved but studied)
MechanismD2/5-HT2A antagonist with potent alpha-1 blockade
Half-life18h parent (EM); 26h P88; 23h P95. PM: 33h, 37h, 31h
Decision GuideWhen to pick each / when to consider an alternative
Iloperidone
Consider when
- Akathisia-prone patient, or prior akathisia on lurasidone/cariprazine/brexpiprazole — iloperidone akathisia ~3.9% in NMA, statistically indistinguishable from placebo (lowest among newer SGAs)
- Anticholinergic sensitivity (cognitive effects, dry mouth, constipation) — zero muscarinic binding (M1 Ki >1000 nM), unlike olanzapine, clozapine, quetiapine
- Need for a non-sedating SGA — low H1 affinity (Ki 437 nM); Schneider-Thoma 2026 NMA confirmed lower sedation than ≥3 comparators
- Patient needs both schizophrenia and bipolar I mania coverage on a single SGA — dual FDA indication
- +1 more
Consider an alternative when
- Severe positive symptoms or rapid response needed — NMA efficacy below olanzapine, risperidone, paliperidone, quetiapine, aripiprazole; mandatory 7-day titration delays therapeutic dose
- Patient on strong CYP2D6 inhibitor (fluoxetine, paroxetine, bupropion) or other QT-prolonging drug — AUC 2–3× higher, QTc rises 9→19 msec; risks compound
- Fall-risk elderly or volume-depleted patient — α1 Ki 0.36 nM (highest in class); orthostatic hypotension 5% at 20–24 mg/day, syncope 0.5%, tachycardia up to 23%
- Cannot complete the 7-day titration — acute hospitalization, expected adherence gaps, or any interruption >3 days requires full re-titration from 1 mg BID
- +1 more
| Axis | Iloperidone SGA |
|---|---|
| CNS | |
Sedation / somnolence | |
Akathisia / EPS | |
| Metabolic | |
Weight gain | |
| Endocrine | |
Prolactin elevation | |
| Autonomic | |
Anticholinergic burden | |
Orthostatic hypotension | |
| Cardiac | |
QTc prolongation | |
Heart rate / tachycardia | |
| Hepatic | |
Liver enzymes / hepatotoxicity | |
| Sexual | |
Sexual dysfunction | |
| GU | |
Priapism | |