We rank perphenazine B tier and think it should be used a little more, because it is more atypical than you think. Compared with haloperidol and fluphenazine it causes less EPS and akathisia (the EPS risk is still moderate), it is a little cleaner metabolically with minimal weight gain, and it is surprisingly decent for negative symptoms.
Our take
B tier, because we kind of think it should be used a little more: it is more atypical than you think.
“I'm putting these in the B tier and that's actually because I kind of think we should encourage them to be used a little bit more because they are more atypical than you think”
1:11:32Antipsychotic Tier List: Ranking the Best and Worst Anti-psychoticsOct 2026
Side effects and strengths
Compared with haloperidol or fluphenazine, the high-potency first-generation drugs, you get less EPS and akathisia, though still a moderate EPS risk. It is a little cleaner metabolically with minimal weight gain, and surprisingly decent for negative symptoms.
“So you get less of the EPS and the akathisia of haloperidol or the fluphenazine, which are the high-potency first-gen antipsychotics. Metabolic, be a little bit cleaner. Minimal weight gain, but still, you do get the moderate EPS risk. Actually, surprisingly decent at negative symptoms”
1:12:44Antipsychotic Tier List: Ranking the Best and Worst Anti-psychoticsOct 2026
From these episodes
- Antipsychotic Tier List: Ranking the Best and Worst Anti-psychoticsOct 2026 · 2 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.