Ziprasidone

What is Ziprasidone

Ziprasidone is an oral and injectable atypical antipsychotic belonging to the benzisoxazole/benzoisothiazol derivatives class.

Atypical antipsychotics are first-line treatment options for the management of schizophrenia and related disorders, with the exception of clozapine.

Ziprasidone has also demonstrated efficacy in adults as monotherapy for acute manic or mixed episodes associated with bipolar I disorder and as maintenance treatment for bipolar I disorder in conjunction with lithium or valproate.

An intramuscular (IM) injection is approved for the treatment of acute agitation in adults with schizophrenia.

Oral ziprasidone has been used ‘off-label’ for the treatment of Tourette’s syndrome, but the data are minimal.

The American Academy of Neurology practice guideline for the treatment of tics in people with Tourette’s syndrome or chronic tic disorders states that ziprasidone is possibly more likely than placebo to reduce tic severity.

However, prescribers should consider the side effect profile of the drug, particularly in comparison with other agents for tics; if ziprasidone is used an ECG is recommended prior to initiation and during treatment.

Ziprasidone may produce relatively less weight gain than some atypical antipsychotics. However, due to a greater capacity of ziprasidone to prolong the QTc interval than many other antipsychotics, prescribers should consider the use of other treatment options prior to choosing to prescribe ziprasidone.

As with all atypical antipsychotics, the labels include a boxed warning regarding an increased mortality risk in elderly patients with dementia-related psychosis.

Brand Name

Geodon

Indications

• agitation
• behavioral or psychological symptoms of dementia
• bipolar disorder
• mania
• schizophrenia
• Tourette’s syndrome

Side Effects

1. abdominal pain
2. agitation
3. agranulocytosis
4. akathisia
5. akinesia
6. alopecia
7. amenorrhea
8. amnesia
9. anemia
10. angina
11. angioedema
12. anorexia
13. anxiety
14. asthenia
15. ataxia
16. atopic dermatitis
17. atrial fibrillation
18. AV block
19. back pain
20. blepharitis
21. bradycardia
22. bullous rash
23. bundle-branch block
24. cataracts
25. chest pain (unspecified)
26. chills
27. choreoathetosis
28. confusion
29. conjunctivitis
30. constipation
31. contact dermatitis
32. cough
33. dehydration
34. delirium
35. depression
36. diabetes mellitus
37. diarrhea
38. diplopia
39. dizziness
40. drowsiness
41. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
42. dysarthria
43. dyskinesia
44. dysmenorrhea
45. dyspepsia
46. dysphagia
47. dyspnea
48. dystonic reaction
49. ecchymosis
50. ejaculation dysfunction
51. elevated hepatic enzymes
52. eosinophilia
53. epistaxis
54. exfoliative dermatitis
55. fever
56. flank pain
57. galactorrhea
58. glycosuria
59. gout
60. gynecomastia
61. headache
62. hematemesis
63. hematuria
64. hemoptysis
65. hepatitis
66. hepatomegaly
67. hostility
68. hyperchloremia
69. hypercholesterolemia
70. hyperglycemia
71. hyperhidrosis
72. hyperkalemia
73. hyperkinesis
74. hyperlipidemia
75. hyperprolactinemia
76. hyperreflexia
77. hypersalivation
78. hypertension
79. hyperthermia
80. hyperthyroidism
81. hypertonia
82. hypertriglyceridemia
83. hyperuricemia
84. hypocalcemia
85. hypochloremia
86. hypoglycemia
87. hypokalemia
88. hypomagnesemia
89. hyponatremia
90. hypothermia
91. hypothyroidism
92. hypotonia
93. impotence (erectile dysfunction)
94. infection
95. influenza
96. injection site reaction
97. insomnia
98. jaundice
99. keratitis
100. keratoconjunctivitis
101. laryngospasm
102. leukocytosis
103. leukopenia
104. lymphadenopathy
105. lymphocytosis
106. maculopapular rash
107. mania
108. melena
109. menorrhagia
110. muscle paralysis
111. myalgia
112. myocarditis
113. myoclonia
114. myopathy
115. nausea
116. neuroleptic malignant syndrome
117. neutropenia
118. nocturia
119. nystagmus
120. ocular hemorrhage
121. oliguria
122. orgasm dysfunction
123. orthostatic hypotension
124. paresthesias
125. pericarditis
126. peripheral edema
127. peripheral neuropathy
128. peripheral vasodilation
129. pharyngitis
130. phlebitis
131. photophobia
132. photosensitivity
133. pneumonitis
134. polycythemia
135. polydipsia
136. polyuria
137. priapism
138. pseudoparkinsonism
139. psychosis
140. pulmonary embolism
141. QT prolongation
142. rash
143. rhabdomyolysis
144. rhinitis
145. seizures
146. serotonin syndrome
147. SIADH
148. sinus tachycardia
149. steatosis
150. Stevens-Johnson syndrome
151. stroke
152. syncope
153. synovitis
154. tardive dyskinesia
155. thrombocytopenia
156. tinnitus
157. torsade de pointes
158. torticollis
159. tremor
160. trismus
161. urinary incontinence
162. urinary retention
163. urticaria
164. vaginal bleeding
165. vertigo
166. vesicular rash
167. visual impairment
168. vomiting
169. water intoxication
170. weight gain
171. withdrawal
172. xerophthalmia
173. xerostomia

Monitoring Parameters

• AIMS assessment
• blood glucose
• CBC
• ECG
• glycosylated hemoglobin A1c (HbA1c)
• LFTs
• neurologic function
• pregnancy testing
• serum creatinine
• serum lipid profile
• serum magnesium
• serum potassium
• serum prolactin
• thyroid function tests (TFTs)
• weight

Contraindications

• abrupt discontinuation
• acute myocardial infarction
• agranulocytosis
• alcoholism
• ambient temperature increase
• bradycardia
• breast cancer
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• cerebrovascular disease
• children
• CNS depression
• coadministration with other CNS depressants
• coronary artery disease
• dehydration
• dementia
• diabetes mellitus
• driving or operating machinery
• dysphagia
• ethanol ingestion
• females
• geriatric
• heart failure
• hepatic disease
• hyperglycemia
• hyperprolactinemia
• hypertension
• hyperthermia
• hypocalcemia
• hypokalemia
• hypomagnesemia
• hypothermia
• hypovolemia
• infants
• infertility
• leukopenia
• long QT syndrome
• malnutrition
• myocardial infarction
• neonates
• neurological disease
• neutropenia
• obesity
• orthostatic hypotension
• Parkinson’s disease
• pregnancy
• pregnancy testing
• priapism
• QT prolongation
• renal failure
• renal impairment
• seizure disorder
• seizures
• serious rash
• strenuous exercise
• stroke
• suicidal ideation
• sunlight (UV) exposure
• tardive dyskinesia
• thyroid disease
• torsade de pointes

Interactions

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