Sedation 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. 

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. 

Zotepine, like ziprasidone, is a potent 5-HT2 antagonist which also reduces the reuptake of noradrenaline. Its side effects, sedation and postural hypotension, are attributable to its antagonistic action on histaminel and alpha-1 receptors. Zotepine, which has not yet been marketed in Europe, may have a similar profile to ziprasidone and could be useful in the treatment of depression associated with schizophrenia. Because of the evident clinical superiority of the atypical antipsychotics over the traditional neuroleptics, the World Psychiatric Association Task Force has... 

In an open 12-week study of ziprasidone in 12 patients with Parkinson s disease and psychosis, two withdrew because of adverse effects one had increased diurnal sedation on day 5 and the other had deterioration of gait at 1 week (7C). The other 10 patients reported significant improvement in psychiatric symptoms and no deterioration in motor symptoms. The small sample size and lack of a control group precluded definitive conclusions. 

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. 

Atypical antipsychotics such as aripiprazole, olanzapine, que-tiapine, risperidone, and ziprasidone are effective as monotherapy or adjunctive therapy with lithium and valproate in the treatment of acute mania. Some antipsychotics have the potential to cause adverse effects such as extrapyramidal reactions, sedation, depression, emotional blunting, sexual dysfunction, weight gain, and orthostatic hypotension. Prophylactic use of antipsychotics may be needed for some patients with recurrent mania or mixed states, but the risks versus benefits must be weighed because of long-term adverse effects (e.g., obesity, type 2 diabetes, hyperlipidemia, hyperprolactinemia, cardiac disease, and tardive dyskinesia). ... 

Ziprasidone is an atypical antipsychotic in clinical use for both schizophrenia and bipolar disorder (see footnote 1). It has a high affinity for dopamine, serotonin, and alpha-adrenergic receptors and a moderate affinity for histamine receptors. The exact mechanism of action of ziprasidone is unknown. However it has been presumed that its antipsychotic activity is mediated primarily by antagonism at dopamine receptors, specifically D2. Serotonin antagonism may also play a role in the effectiveness of ziprasidone. Antagonism at histaminic and alpha adrenergic receptors are likely responsible for some of the side effects of ziprasidone, such as sedation and orthostasis. The worldwide sales of ziprasidone are expected to be 1 billion in 2009. 

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