Adult Dosing
Acute agitation in schizophrenia
- 10-20 mg IM PRN
- May give 10 mg IM q2 hrs or 20 mg IM q4 hrs (Max: 40 mg/day for 3 days)
Notes:- Replace IM with PO as soon as possible; avoid coadministration of IM and oral dose
- Discontinue therapy if absolute neutrophil count is <1000/mm3
- Consider discontinuation of therapy on signs of unexplained decreased WBC
- IM administration for more than 3 consecutive days has not been studied
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. This drug is not approved for the treatment of dementia-related psychosis [US Block Box Warning]
- Ziprasidone is known to prolong QT interval. Avoid use in combination with other drugs that are known to prolong the QTc interval
- QT prolongation with life-threatening CV events including torsades de pointes and/or sudden death may occur. This risk is further increased with the use of drugs that prolong the QTc interval, bradycardia, hypokalemia or hypomagnesemia, and the presence of congenital prolongation of the QT
- Discontinue treatment in patients who have persistent QTc measurements more than 500 msec. In patients experiencing symptoms indicative of torsade de pointes further evaluation such as Holter monitoring may be essential
- Leukopenia, neutropenia, and agranulocytosis have occurred with antipsychotics. Frequently monitor complete blood count (CBC) during the first few months of therapy in patients having a history of a clinically significant low white blood cell count (WBC) or drug induced leukopenia/neutropenia. Consider discontinuation of therapy at the first sign of a clinically significant decline in WBC in the absence of other causative factors
- Orthostatic hypotension associated with dizziness, tachycardia, bradycardia and, in some patients, syncope, have occurred especially during initial dose titration. Cardio vascular disease can predispose patients to hypotension.
- Antipsychotics disrupt the ability to reduce core body temperature. Use with caution in patients who may experience conditions that may contribute to an elevation in core body temperature (e.g.,, exposure to extreme heat, strenuous exercise, concomitant anticholinergic therapy)
- Hyperglycemia associated with ketoacidosis or hyperosmolar coma or death, may occur. Monitor patients for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Monitor patients with established diagnosis of diabetes mellitus regularly for worsening of glucose control
- Esophageal dysmotility and aspiration have occurred with antipsychotic drugs
- Potentially irreversible, involuntary, dyskinetic movements may also develop
- Risk of developing irreversible tardive dyskinesia increases as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increases. Elderly women are more prone to syndrome of potentially irreversible, involuntary, dyskinetic movements. Syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn
- Prescribe this drug in a manner that is most likely to minimize the risk of tardive dyskinesia. Discontinue therapy on occurrence of signs and symptoms of tardive dyskinesia. Periodically reassessed need for continued treatment
- Measure baseline potassium and magnesium levels. Correct electrolyte disturbances before starting therapy. Periodically monitor potassium and magnesium in patients started on diuretic treatment during ziprasidone therapy.
- Neuroleptic Malignant Syndrome manifesting with hyperpyrexia, muscle rigidity, altered mental status and autonomic instability has been reported in association with administration of antipsychotic drugs
- Carefully consider potential reintroduction of drug therapy in patients recovered from NMS as recurrences of NMS can occur
- Carefully diagnose patients for serious medical illness (e.g. pneumonia, systemic infection, etc.) ,untreated or inadequately treated extrapyramidal signs and symptoms, central anticholinergic toxicity, heart stroke, drug fever, and primary central nervous system pathology
- Immediately discontinue antipsychotic drugs and other drugs not essential for concomitant therapy, provide intensive symptomatic treatment, carefully monitor patients and provide treatment for concomitant serious medical problems for management of NMS
- On appearance of rash with unknown etiology discontinue therapy
- Patients treated with antipsychotic agents often have elevation in prolactin levels
- Observe patients treated with antidepressants for clinical worsening, suicidality, and unusual changes in behavior. Prescribe the lowest dose and monitor carefully
- Ziprasidone (IM) is indicated for treatment of acute agitation episodes in schizophrenia. Therapy should be switched to oral tablets as soon as possible
- It is intended for intramuscular use only and should not be administered intravenously
- Safety of administering ziprasidone IM to schizophrenic patients already taking oral ziprasidone has not been established
- Monitor fasting glucose at baseline if diabetes risk factors, then periodically
- Monitor K and Mg at baseline, then if diuretic is added, continue periodically
- Perform ECG at baseline if cardiac risk factors, then periodically
- Atypical antipsychotics have been associated with metabolic changes (eg, hyperglycemia, dyslipidemia, and body weight gain) that may increase cardiovascular/cerebrovascular risk
Cautions: Use cautiously in
- Hepatic impairment
- Cardiac disease
- History of IHD
- Cardiac arrhythmia
- Heart failure
- Conduction abnormality
- Cerebrovascular disease
- History of NMS
- Alzheimer’s dementia
- Diabetes mellitus
- Risk factors for diabetes mellitus
- Seizure disorder
- Dehydration
- Hypotension
- Hypovolemia
- Concomitant use of QT prolonging agent
- Geriatric Patients
Pregnancy Category:C
Breastfeeding: Limited published experience with ziprasidone during breastfeeding, hence other antipsychotic agents are preferred. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 25 August 2011). As per manufacturer breastfeeding should be prohibited by women receiving this drug.
