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 — Paliperidone(click to collapse)
1/4 selected
Paliperidone
Invega · INVEGA SUSTENNA
Second-Generation Antipsychotic
FDA-approved indications
- Schizophrenia (adults)
- Schizoaffective disorder — mono or adjunct to mood stabilizers/antidepressants (adults)
Off-label uses
- Bipolar disorder
- Agitation in dementia (limited direct evidence; extrapolated from risperidone data)
Half-life23 hours
Decision GuideWhen to pick each / when to consider an alternative
Paliperidone
Consider when
- Hepatic impairment — 80% renal clearance minimizes hepatic metabolism; no dose adjustment for hepatic impairment
- CYP drug interaction burden is high — avoids CYP2D6/3A4 pathways that complicate risperidone, aripiprazole, and others
- Long-acting injection for non-adherence — three LAI formulations: monthly (Sustenna), 3-monthly (Trinza), 6-monthly (Invega Hafyera)
- Schizoaffective disorder — FDA-approved indication distinct from risperidone; broadest psychotic disorder coverage with LAI
- +1 more
Consider an alternative when
- Hyperprolactinemia concern — class-top prolactin elevation among SGAs; galactorrhea, amenorrhea, osteoporosis, sexual dysfunction
- GI structural narrowing (Crohn's, diverticular disease) — osmotic ER tablet shell may cause obstruction; ghost tablets in stool
- Severe renal impairment — primarily renally cleared; CrCl <50 mL/min requires dose reduction; not recommended CrCl <10
- Cost or formulary constraint — brand-only ER and LAI formulations at significant premium over generic risperidone
- +1 more
| Axis | Paliperidone SGA |
|---|---|
| Boxed Warnings | |
Agranulocytosis / severe neutropenia | |
Cerebrovascular events (elderly w/ dementia) | |
Neuroleptic malignant syndrome (NMS) | |
| 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 | |
| Cardiac | |
QTc prolongation | |
| GI | |
Nausea / GI (general) | |
| Sexual | |
Sexual dysfunction | |
| GU | |
Priapism | |
| Interactions | |
CYP interactions / DDI profile | |
| Pregnancy | |
Lactation / breastfeeding safety | |
| Drug-specific / distinctive axes | |
Dysphagia (class warning) only in Paliperidone | |