What are the antipsychotic medications with the fewest side effects?

Nov 19, 2025 Source: Cainiu Health

Dr. Zhang Baohua

Introduction

There is generally no such thing as an antipsychotic with the absolute least side effects, but those with relatively fewer side effects may include aripiprazole, quetiapine, risperidone, ziprasidone, and olanzapine (at low doses). Aripiprazole: This medication has minimal impact on weight, blood glucose, and lipid levels, and has a lower incidence of extrapyramidal side effects. Common mild side effects include headache, nausea, or insomnia.

Generally speaking, there is no absolute statement about which antipsychotic has the least side effects. However, medications with relatively fewer side effects may include aripiprazole, quetiapine, risperidone, ziprasidone, and olanzapine (when used at low doses). A detailed analysis is as follows:

1. Aripiprazole: This medication has minimal impact on body weight, blood glucose, and lipid levels, with a lower incidence of extrapyramidal symptoms. Common mild side effects include headache, nausea, or insomnia. Most patients tolerate it well, making it suitable for individuals requiring long-term treatment who are concerned about metabolic parameters.

2. Quetiapine: When used at low doses, its side effects are generally mild, with limited impact on cognitive function. Possible side effects include slight drowsiness or dizziness. Its effect on metabolic indicators is less pronounced compared to some conventional antipsychotics. Patients should avoid sudden changes in posture during treatment to prevent dizziness.

3. Risperidone: At standard doses, extrapyramidal symptoms and metabolic side effects are relatively manageable. Mild anxiety, headache, or minor weight changes may occur. Adjusting the dose can further reduce side effects, and regular monitoring of relevant health indicators is recommended.

4. Ziprasidone: It has minimal effects on weight and metabolism, with a low incidence of extrapyramidal symptoms. Common side effects include mild drowsiness or dry mouth. It should be taken with food to ensure adequate absorption. Overall, it has a high safety profile.

5. Olanzapine (at low doses): When used at low doses, metabolic side effects are significantly reduced compared to standard dosing. Possible side effects include mild drowsiness or fatigue, with minimal impact on cognitive function. Strict adherence to the recommended dosage is essential to control side effects.

Medication must be taken strictly under a doctor's guidance; self-selection or dose adjustment is not advised. Regular follow-up tests for weight, blood glucose, lipid levels, and liver and kidney function are necessary during treatment. Any physical discomfort should be reported promptly. If severe side effects occur, immediate medical attention is required to adjust the treatment plan. A healthy lifestyle should also be maintained to support therapy.

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