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Indications:

for the treatment of schizophrenia, and the intramuscular injection form of ziprasidone is approved for acute agitation in schizophrenic patients. Ziprasidone has also received approval for acute treatment of mania and mixed states associated with bipolar disorder.

Contraindications:

QT Prolongation Because of ziprasidone’s dose-related prolongation of the QT interval and the known association of fatal arrhythmias with QT prolongation by some other drugs, ziprasidone is contraindicated: •in patients with a known history of QT prolongation (including congenital long QT syndrome) •in patients with recent acute myocardial infarction •in patients with uncompensated heart failure Pharmacokinetic/pharmacodynamic studies between ziprasidone and other drugs that prolong the QT interval have not been performed. An additive effect of ziprasidone and other drugs that prolong the QT interval cannot be excluded. Therefore, ziprasidone should not be given with: •dofetilide, sotalol, quinidine, other Class Ia and III anti-arrhythmics, mesoridazine, thioridazine, chlorpromazine, droperidol, pimozide, sparfloxacin, gatifloxacin, moxifloxacin, halofantrine, mefloquine, pentamidine, arsenic trioxide, levomethadyl acetate, dolasetron mesylate, probucol or tacrolimus. •other drugs that have demonstrated QT prolongation as one of their pharmacodynamic effects and have this effect described in the full prescribing information as a contraindication or a boxed or bolded warning [see WARNINGS AND PRECAUTIONS]. Hypersensitivity Ziprasidone is contraindicated in individuals with a known hypersensitivity to the product.

Adverse reactions:

Ziprasidone received a black box warning due to increased mortality in elderly patients with dementia-related psychosis.[7] It also slightly increases the QTc interval in some patients and increases the risk of a potentially lethal type of heart arrhythmia known as torsades de pointes. Ziprasidone should be used cautiously in patients taking other medications likely to interact with ziprasidone or increase the QTc interval.[12] Ziprasidone is known to cause activation into mania in some bipolar patients.[13][14][15] This medication can cause birth defects, according to animal studies, although this side effect has not been confirmed in humans.[7] Adverse events reported for ziprasidone include severe chest pains, sedation, insomnia, orthostasis, life-threatening neuroleptic malignant syndrome, akathisia, and the development of permanent neurological disorder tardive dyskinesia. Rarely, temporary speech disorders may result. Recently, the FDA required the manufacturers of some atypical antipsychotics include a warning about the risk of hyperglycemia and Type II diabetes with atypical antipsychotics. Some evidence suggests that ziprasidone may not be as bad as some of the other atypical antipsychotics (namely, olanzapine (Zyprexa)) at causing insulin resistance and weight gain.[16][17][18][19] In fact, in a trial of long term therapy with ziprasidone, overweight patients (BMI > 27) actually had a mean weight loss overall.[7] Ziprasidone, though, is not a weight loss drug. The weight loss reflected in this study on ziprasidone was really reflective of patients who had gained weight on other antipsychotics who were now trending back toward their baseline.[citation needed] According to the manufacturer insert, ziprasidone caused an average weight gain of 2.2 kg (4.8 lbs) (which is significantly lower than other atypicals–clozapine and olanzapine).

Interactions:

Ziprasidone has a modest effect on the electrical activity of the heart which can be seen on the electrocardiogram (EKG) as a prolongation of the QT-interval. (See discussion below.) Other drugs which also affect the QT interval can add to the effects of ziprasidone and lead to serious disturbances in the rhythm of the heart. Due to the potential for such additive effects on the QT interval, ziprasidone should not be taken with thioridazine (Mellaril), quinidine (Quinidex), moxifloxacin (Avelox), pimozide (Orap), sotalol (Betapace), dofetilide (Tikosyn), and sparfloxacin (Zagam). Carbamazepine (Tegretol) increases the body’s ability to eliminate ziprasidone and, therefore, may reduce the levels and lessen the effectiveness of ziprasidone. Conversely, ketoconazole (Nizoral) reduces the body’s ability to eliminate ziprasidone and may cause increases in levels of ziprasidone and more side effects. Ketoconazole does this by blocking the enzyme that eliminates ziprasidone, cytochrome P450 3A4. Other drugs that also block this enzyme and may increase the levels of ziprasidone include itraconazole (Sporanox), fluconazole (Diflucan), erythromycin, clarithromycin (Biaxin), nefazodone (Serzone), verapamil (Calan, Isoptin, Verelan), and diltiazem (Cardizem, Tiazac, Dilacor)

Warnings:

Before taking ziprasidone, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: heart problems (e.g., QTc prolongation, arrhythmias, recent heart attack, heart failure). Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver problems, mineral imbalance (e.g., hypokalemia, hypomagnesemia), strokes (cerebrovascular disease), history of low blood pressure (e.g., dehydration, hypovolemia), seizures, swallowing difficulty, Alzheimer’s disease, breast cancer, diabetes (or family history), obesity. This drug may make you dizzy or drowsy; use caution engaging in activities requiring alertness such as driving or using machinery. Limit alcoholic beverages. To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position. Caution is advised when using this drug in the elderly because they may be more sensitive to the side effects of the drug, especially the drowsiness and blood pressure-lowering effects. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. It is not known whether this drug passes into breast milk. Because of the potential risk to the infant, breast-feeding while using this drug is not recommended

Form:

SOLUTION FOR INJECTION

Dosage and Administration

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Consultants Corner

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

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Samir Moussa M.D. ENT Specialist
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