Deaths with ziprasidone

Atypical antipsychotics may be helpful in managing the delusions and agitated behavior that can accompany dementia. These medications, include risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and olanzapine (Zyprexa). All antipsychotics, typical and atypical, appear to increase the risk of death in patients with dementia and psychosis. This appears as a warning in the package inserts of the newer drugs. A prudent approach is to discuss this risk with the caregiver, use the lowest effective dose, and monitor for effectiveness. 

Ziprasidone, pimozide, mesoridazine, and thioridazine have been shown to prolong the QT interval, and drugs with this potential have been associated with torsade de pointes-type arrhythmias and sudden death. Perform a baseline ECG and measure serum potassium and magnesium before initiation of treatment and periodically during treatment, especially during a period of dose adjustment. Patients with QT interval over 450 msec should not receive mesoridazine or thioridazine. Avoid ziprasidone in patients with histories of significant cardiovascular illness (eg. 

The question of the effect of ziprasidone on the QTC interval has been analysed in an extensive review (18). It is generally accepted that 440 ms is the upper limit of normality, and the authors concluded that ziprasidone clearly prolongs the QTC interval, but that the clinical consequences of this effect are uncertain, and that so far no direct association with torsade de pointes, sudden death, or increased cardiac mortality has been observed. However, they provided recommendations about its use. 

Psychiatric The incidence of suicide-related events in patients with schizophrenia or bipolar disorder taking aripiprazole has been studied using administrative data from three US sources [65 "]. Suicide attempts and death by suicide were assessed in patients aged at least 18 years. Among 20489 antipsychotic drug users (8985 patient-years), unadjusted suicide event rates per 1000 patient-years were 21 for aripiprazole 24 for olanzapine 32 for quetiapine 20 for risperidone and 49 for ziprasidone. Compared with current users of the other antipsychotic... 

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