We have fewer data for tadalafil in the psychiatric setting; however, compared to other agents in the class, its long duration of action may improve spontaneity, and the lack of interaction with meals may offer advantages. Tadalafil is an especially good choice for men who have both prostatic hypertrophy and erectile dysfunction (ED). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Perphenazine, first introduced in 1957, is an older first-generation agent that enjoyed a big boost in popularity after the 2005 CATIE trial found it to be as effective as most second-generation agents with minimal weight gain or metabolic problems. It has become a favorite go-to antipsychotic for many clinicians—an effective, well-tolerated, and inexpensive alternative to second-generation antipsychotics. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Bremelanotide (marketed as the “female Viagra”) is a melanocortin receptor agonist that is modestly effective in increasing sexual desire in women, though it doesn’t affect sexual functioning. Disadvantages include the fact that it requires self-injection and carries a 40% rate of nausea as a side effect. It’s worth trying in some patients, but don’t expect miracles. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Benztropine is an anticholinergic medication that is the go-to agent for treating and preventing antipsychoticinduced extrapyramidal symptoms (EPS). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Avanafil is the newest PDE-5 inhibitor to come to market. Its potential advantage is a somewhat faster onset than any of the other ED drugs. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Cariprazine, like aripiprazole and brexpiprazole, is a partial dopamine agonist. Some preliminary data imply that it might be effective for negative symptoms, but it’s too soon to tell. Beyond that, it appears similar to the other two partial dopamine agonists with regard to akathisia and minimal weight gain. It is available as a brand name only and is therefore very expensive (as opposed to aripiprazole, which has gone generic). From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Hydroxyzine is an antihistamine that is a good non-addictive option when your patient needs a rapid-acting anxiolytic. But beware of its anticholinergic effects, especially in patients who take many doses throughout the day From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Brexpiprazole is a cousin of aripiprazole and is also a partial dopamine agonist. While it has a very similar efficacy profile to aripiprazole, it was recently awarded approval for treatment of agitation in Alzheimer’s dementia—the first drug to gain this indication. However, effect sizes were small, and safety in the elderly remains a concern. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Quetiapine’s low risk for EPS and broad spectrum of efficacy make it an appealing first-choice agent. However, sedation, weight gain, and orthostasis may limit use. Dosing at bedtime, or switching to XR, may help reduce daytime sedation. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).

Excessive drooling, usually more severe at night. From Medication Fact Book for Psychiatric Practice, 7th Edition (2023).