Aripiprazole, brexpiprazole and cariprazine differ from all other second-generation antipsychotics due to partial agonism at the dopamine D2 and D3 receptors. In contrast to aripiprazole, brexpiprazole has lower intrinsic dopamine D2 activity and higher affinity for the serotonin 5-HT1A and 5-HT2A receptors, while cariprazine has the highest affinity for the dopamine D3 receptor, and the longest half-life. The main adverse effect of dopamine receptor partial agonists (DRPAs) is akathisia of low-to-moderate severity, which occurs in a small proportion of patients, usually in the first few weeks of treatment. While definitive conclusions concerning differences between the DRPAs require head-to-head comparison studies, on the available evidence, akathisia is probably least likely to occur with brexpiprazole and most likely with cariprazine; the risk of akathisia with aripiprazole lies in between. Weight-gain risk is low with aripiprazole and cariprazine, but moderate with brexpiprazole. Risk of sedation is low with DRPAs, as is risk of insomnia and nausea. Partial dopamine agonism leads to a low risk for hyperprolactinaemia (and probably a low risk of sexual dysfunction). Prolactin concentrations fall in some patients (particularly those with elevated levels prior to initiating the drugs). Rates of discontinuation due to adverse effects in pivotal studies were low, and on the whole, DRPAs are well tolerated. Aripiprazole has been implicated in pathological gambling and other impulse control behaviours, likely due to partial dopamine agonist activity (there have been no reports with brexpiprazole and cariprazine). The risks for diabetes and tardive dyskinesia with DRPAs are unknown, but are likely to be low. On the basis of tolerability, DRPAs should be considered as first-line treatment options, particularly in patients with early schizophrenia.

由于多巴胺 D2 和 D3 受体的部分激动作用，阿立哌唑、brexpiprazole 和卡利拉嗪与所有其他第二代抗精神病药不同。与阿立哌唑相比，brexpiprazole 具有较低的内在多巴胺 D2 活性和较高的血清素 5-HT1A 和 5-HT2A 受体亲和力，而卡利拉嗪对多巴胺 D3 受体的亲和力最高，半衰期最长。多巴胺受体部分激动剂 (DRPA) 的主要不良反应是低至中度严重程度的静坐不能，发生在一小部分患者中，通常发生在治疗的前几周。虽然关于 DRPA 之间差异的明确结论需要头对头的比较研究，但根据现有证据，使用 brexpiprazole 可能最不可能发生静坐不能，而使用卡利拉嗪最有可能发生静坐不能；阿立哌唑导致静坐不能的风险介于两者之间。阿立哌唑和卡利拉嗪的体重增加风险较低，但布立哌唑的体重增加风险中等。DRPA 的镇静风险较低，失眠和恶心的风险也较低。部分多巴胺激动导致高催乳素血症的风险较低（并且可能导致性功能障碍的风险较低）。一些患者的催乳素浓度下降（特别是那些在开始用药前水平升高的患者）。关键研究中由于不良反应导致的停药率很低，总体而言，DRPA 的耐受性良好。阿立哌唑与病理性赌博和其他冲动控制行为有关，可能是由于部分多巴胺激动剂活性（没有关于布立哌唑和卡利拉嗪的报道）。DRPA 导致糖尿病和迟发性运动障碍的风险尚不清楚，但很可能很低。在耐受性的基础上，应考虑将 DRPAs 作为一线治疗选择，特别是在早期精神分裂症患者中。