2023 Updated

Oral antipsychotic medicines – namely aripiprazole, chlorpromazine, haloperidol, olanzapine, paliperidone, quetiapine, risperidone – should be offered for adults with a psychotic disorder (including schizophrenia), carefully balancing effectiveness, side-effects and individual preference.
Strength of recommendation: STRONG
Certainty of evidence: MODERATE

Clozapine should be considered for adults with a treatment-resistant psychotic disorder (including schizophrenia) under mental health specialist supervision, carefully balancing effectiveness, side-effects and individual preference.
Strength of recommendation: CONDITIONAL
Certainty of evidence: MODERATE

2023 validated

Second-generation antipsychotics (with the exception of clozapine) may be considered in individuals with psychotic disorders (including schizophrenia) as an alternative to haloperidol or chlorpromazine if availability can be assured and cost is not a constraint.
Strength of recommendation: CONDITIONAL
Certainty of evidence: LOW

In individuals with psychotic disorders (including schizophrenia), minimal effective dose of antipsychotics should be used, paying attention to minimizing adverse effects.
Strength of recommendation: STRONG
Certainty of evidence: VERY LOW

In women with psychotic disorders (including schizophrenia) who are planning a pregnancy or pregnant or breastfeeding, low-dose oral haloperidol or chlorpromazine may be considered.
Strength of recommendation: CONDITIONAL
Certainty of evidence: LOW

Recommendation(s)

Haloperidol or chlorpromazine should be routinely offered to individuals with psychotic disorders (including schizophrenia).
Strength of recommendation: STRONG
Quality of evidence: VERY LOW

Second-generation antipsychotics (with the exception of clozapine) may be considered in individuals with psychotic disorders (including schizophrenia) as an alternative to haloperidol or chlorpromazine if availability can be assured and cost is not a constraint.
Strength of recommendation: CONDITIONAL
Quality of evidence: LOW

For individuals with psychotic disorders (including schizophrenia) who do not respond to adequate dose and duration of other antipsychotic medicines, clozapine may be considered by non-specialist health care providers, preferably under the supervision of mental health professionals, only if routine laboratory monitoring is available.
Strength of recommendation: CONDITIONAL
Quality of evidence: LOW

In individuals with psychotic disorders (including schizophrenia), minimal effective dose of antipsychotics should be used, paying attention to minimizing adverse effects.
Strength of recommendation: STRONG
Quality of evidence: VERY LOW

In women with psychotic disorders (including schizophrenia) who are planning a pregnancy or pregnant or breastfeeding, low-dose oral haloperidol or chlorpromazine may be considered.
Strength of recommendation: CONDITIONAL
Quality of evidence: LOW