Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.
Clinician reference tool — not a prescriber, not a diagnosis, not medical advice. Deterministic, phase-gated suggestions to think with, grounded in the Canadian Schizophrenia Guidelines (CPA 2017), APA 2020, NICE CG178 and the INTEGRATE 2025 algorithm. Schizophrenia is high-stakes — psychiatric assessment, current product monographs and the treating clinician’s judgement are always required. Runs entirely in your browser — no data is collected.

Evidence: Fountoulakis KN 2025 · sources last checked 2026-07-22

Schizophrenia antipsychotic selector

Choose the current illness phase — first-episode psychosis, acute relapse / stabilization, maintenance, or treatment-resistant schizophrenia — and the phase selects the option set, exactly as the guidelines do. Clozapine is gated to treatment-resistant illness; long-acting injectables surface for adherence. Add the predominant symptoms and any safety flags for ranked, reasoned suggestions across the Health Canada-approved formulary, with the guideline reasoning and references behind each.

Guideline lens

Illness phase *required — this gates the options

The phase determines which agents lead — e.g. clozapine appears only for treatment-resistant schizophrenia; olanzapine is down-weighted first-line in first-episode patients; LAIs lead in maintenance.

Clinical profile

Prior adequate antipsychotic trials (optional)

Predominant symptoms (optional)

Safety & modifier flags

NMS is a red flag — it suppresses routine recommendations and shows the medical-emergency message. Adherence surfaces the LAI pathway; suicidality foregrounds crisis resources; metabolic / prolactin / QTc / EPS steer the ranking.

Safety & guideline notes

  • • Per the Canadian Schizophrenia Guidelines (CPA, 2017): treatment is phase-based. First-episode — a second-generation antipsychotic at LOWER doses, choosing on tolerability (higher response but greater EPS/metabolic sensitivity). Acute relapse / maintenance — continue an effective agent at the lowest effective dose; use LAIs to support adherence and prevent relapse. Treatment-resistant schizophrenia (≥2 adequate trials) — CLOZAPINE is the evidence-based option and should not be delayed. Metabolic monitoring applies to all antipsychotics.
  • • Metabolic monitoring applies to ALL antipsychotics: baseline and ongoing weight / waist, blood pressure, fasting glucose (or HbA1c) and lipids; olanzapine and clozapine carry the highest burden.
  • • This tool assumes a confirmed diagnosis of schizophrenia and does not diagnose, prescribe, or set doses. It is high-stakes; psychiatric assessment, the live Health Canada product monographs, and the treating clinician's judgement are always required.

Select the illness phase to begin.

First-episode, Acute relapse, Maintenance, or Treatment-resistant — the phase gates which agents lead (and where clozapine appears).

References

  1. [1]Remington G, Addington D, Honer W, Ismail Z, Raedler T, Teehan M. Guidelines for the Pharmacotherapy of Schizophrenia in Adults (Canadian Schizophrenia Guidelines / CPA). Can J Psychiatry 2017;62(9):604–616. link
  2. [2]American Psychiatric Association. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia (3rd ed.), 2020. link
  3. [3]NICE Clinical Guideline CG178 — Psychosis and schizophrenia in adults: prevention and management (National Institute for Health and Care Excellence, 2014; updated). link
  4. [4]Fountoulakis KN, et al. INTEGRATE: international guidelines for the algorithmic treatment of schizophrenia. Lancet Psychiatry 2025. link
  5. [5]Health Canada — Drug Product Database & product monographs (aripiprazole/Abilify & Maintena, risperidone/Risperdal & Consta, paliperidone/Invega & Sustenna/Trinza, olanzapine/Zyprexa, quetiapine/Seroquel, ziprasidone/Zeldox, lurasidone/Latuda, asenapine/Saphris, cariprazine/Vraylar, brexpiprazole/Rexulti, clozapine/Clozaril & GenClozapine, haloperidol/Haldol & LA, flupentixol/Fluanxol, zuclopenthixol/Clopixol, perphenazine/Trilafon, loxapine/Loxapac, chlorpromazine/Largactil). link
  6. [6]Health Canada approves VRAYLAR (cariprazine) for the treatment of bipolar I disorder and schizophrenia in adults (Notice of Compliance 22 April 2022). link
  7. [7]Health Canada approves REXULTI (brexpiprazole) as a treatment for schizophrenia in adults (Otsuka/Lundbeck, 2017). link
  8. [8]Clozapine haematologic monitoring — national registry for agranulocytosis; CBC/ANC weekly for 26 weeks, then biweekly for 26 weeks, then monthly (Canadian schedule). Myocarditis risk is greatest in the first weeks of treatment. Verify against the current Clozaril / GenClozapine product monograph and the applicable registry. link
  9. [9]Kane J, Honigfeld G, Singer J, Meltzer H. Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988;45(9):789–796. link
  10. [10]Meltzer HY, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003;60(1):82–91. link
  11. [11]Leucht S, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet 2013;382(9896):951–962. link
  12. [12]Correll CU, et al. / Canadian Schizophrenia Guidelines — long-acting injectable antipsychotics for relapse prevention and adherence (paliperidone palmitate 1-/3-monthly, aripiprazole once-monthly, risperidone LAI, FGA depots). See CPA 2017 (ref 1) and current Health Canada monographs. link