Akathisia 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. 

The most common side effects are headache, dyspepsia, nausea, constipation, abdominal pain, somnolence, and EPS. Ratings of parkinsonism and akathisia with ziprasidone, 120 mg/day, did not differ from those with placebo. Although dizziness has been reported, rates of orthostatic hypotension have not differed from rates associated with placebo in controlled clinical trials. 

In one double-blind, randomized, placebo-controlled study, patients were given a daily dose of 40 or 120 mg ziprasidone or placebo for 28 days in 132 patients ( 136). There was a statistically significant improvement in psychotic symptoms versus placebo in the 120 mg/day ziprasidone group as measured by the total BPRS and the CGI scores. Evaluations for parkinsonian symptoms, akathisia, abnormal movements, and sedation did not reveal any notable treatment effects. No significant differences existed between drug and placebo in the total number of adverse events, laboratory test abnormalities, or more serious adverse events. Thus, this study documented that 60 mg ziprasidone twice daily was an effective strategy with negligible risks. 

Ziprasidone has been used in 28 children and adolescents (aged 7-17 years) with Tourette s syndrome in an 8-week pilot study (11). They were randomly assigned to ziprasidone (5-40 mg/day n = 16) or placebo (n = 12). Ziprasidone significantly reduced tic frequency. There was one case each of somnolence and akathisia, both with the highest dose of ziprasidone these were considered to be severe but did not necessitate withdrawal. 

In a double-blind study, 144 agitated patients who required emergency sedation were randomized to ziprasidone 20 mg (n = 46), droperidol 5 mg (n = 50), or midazolam 5 mg (n = 48) (13). Those who were sedated with droperidol or ziprasidone required rescue medications to achieve adequate sedation less often than those who were sedated with midazolam more remained agitated at 15 minutes after ziprasidone. There was akathisia in one patient who received droperidol, one who received midazolam (and subsequently droperidol rescue sedation), and four who received ziprasidone. There were no other adverse events. 

In a randomized, Phase III, double-blind study, ziprasidone 80 mg/day and 160 mg was more effective than placebo in patients with acute exacerbations of schizophrenia or schizoaffective disorders (n = 302) (20). After 6 weeks, somnolence (19%) and akathisia (13%) were more frequent with ziprasidone 160 mg than with placebo (5 and 7% each). Benzatropine was required at some time during the study by 20% of the patients taking ziprasidone 80 mg/day, 25% of those taking ziprasidone 160 mg/day, and 13% of those taking placebo. The long-term safety of ziprasidone is unknown. 

Olanzapine, quetiapine, and risperidone are preferred alternative atypicals aripiprazole and ziprasidone are newer agents and may initially cause akathisia-like reactions clozapine is usually reserved for treatment-resistant mania or mixed states. 

Quetiapine has sedative effects and may cause weight gain, bnt it causes minimal extrapyramidal side effects or prolactin elevations. Ziprasidone canses few extrapyramidal side effects, does not significantly increase prolactin levels, and has a lower risk of causing weight gain. Aripiprazole has low extrapyramidal side effects (except for initial akathisia), minimal effect on prolactin levels, and is considered to be weight neutral. 

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. 

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