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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