Extrapyramidal symptoms ziprasidone

Ziprasidone (Geodon). Ziprasidone is indicated for the treatmet of acute mania with typical doses of 40-80 mg twice a day. Ziprasidone is well tolerated, with the most common side effects being sedation, extrapyramidal symptoms, and akathisia. Low magnesium or potassium may cause potentially serious cardiac conduction problems with ziprasidone. 

Delusions/Psychosis. Demented patients who are acutely psychotic and agitated should be treated in much the same manner as demented patients with delirium. Low doses of a high potency conventional antipsychotic like haloperidol were once preferred. This was mainly because it can be given both orally and by injection. In recent years, the atypical antipsychotic ziprasidone, which is now also available in oral and injectable forms, has superseded haloperidol as the preferred agent when treating the acutely psychotic and agitated patient with dementia. As previously noted, ziprasidone affords the same tranquilizing benefit as haloperidol, it can now be administered via injection when necessary, and it avoids the problematic extrapyramidal symptoms of haloperidol to which patients with dementia are often keenly sensitive. 

We prefer low doses of atypical antipsychotics as a first-line treatment. In this way, the threat of extrapyramidal symptoms is largely avoided without having to use a second anticholinergic medication to offset antipsychotic side effects. Risperidone 0.25-0.5mg/day, olanzapine 2.5mg/day, quetiapine 25mg/day, ziprasidone 20mg/day, or aripiprazole 2.5-5mg/day are reasonable starting doses. The typically higher doses used to treat schizophrenia are usually not necessary. 

A study of intramuscular ziprasidone versus intramuscular haloperidol for managing agitation in a Chinese population was conducted [14 ]. There were fewer adverse events with ziprasidone particularly extrapyramidal symptoms and the most common adverse events with ziprasidone were dizziness and somnolence. Most subjects had no clinically significant changes in ECG five ziprasidone and three haloperidol patients had a QTcF>450ms. 

Controlled Studies A study of pooled data from nine randomised, double-blind, placebo-controlled, acute studies of ziprasidone in bipolar mood disorder and schizophrenia was conducted [279 -]. The risk of discontinuation due to adverse events or >7% weight gain was not different to placebo. The risk for akathisia was significantly higher for mood disorders and the risk of extrapyramidal symptoms and somnolence (dose dependent) was significantly higher for both mood disorders and schizophrenia compared to placebo. 

A 6-week, randomised, double-blind, placebo-controlled trial of ziprasidone for acute depression reported no adverse weight changes or extrapyramidal symptoms [280 -]. 

Ziprasidone is apparently well tolerated, with a limited potential to cause extrapyramidal adverse effects or weight gain (4). Out-patients who partly respond to conventional antipsychotic drugs, risperidone, or olanzapine may have improved control of psychotic symptoms after switching to ziprasidone, according to the results of a reanalysis of 6-week, multicenter, randomized, open, parallel-group studies in patients with schizophrenia who had previously taken conventional antipsychotic drugs (n = 108), olanzapine (n = 104), or risperidone (n = 58) these results have been published in two different journals (5, 6). 

Conventional antipsychotics improve symptoms of hyperactivity and impulsivity, but may have negative effects on learning and cognitive functioning as well as extrapyramidal side effects (e.g., dystonia and tardive dyskinesia) that limit their usefulness. The atypical antipsychotics risperidone, olanzapine, quetiapine, and ziprasidone have been used to control severe aggression in refractory cases of ADHD, particularly if conduct disorder or bipolar disorder coexists. More studies are needed to clarify their place in therapy. ... 

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