Ziprasidone

Delivered via injection, Ziprasidone alters brain chemicals to treat agitation associated with schizophrenia.

Overview

Ziprasidone helps to control periods of severe agitation and anxiety in patients with diagnosed schizophrenia. Designed for short-term use only, intra-muscular delivery enables intense agitation to be controlled rapidly.

By rebalancing the patient’s levels of dopamine and serotonin, Ziprasidone successfully improves mood, behavior and thinking patterns. As a result, anxiety and agitation caused by schizophrenia can be reduced significantly once intra-muscular Ziprasidone has been administered.

Appropriate for schizophrenic patients only, Ziprasidone should not be used to control behavioral problems or psychosis caused by dementia or other conditions. Although not a long-term treatment method or curative solution, intra-muscular Ziprasidone is ideal for use in clinical settings. Patients exhibiting uncontrollable agitation or outbursts can be treated effectively and quickly when Ziprasidone is administered via injection.

While intra-muscular Ziprasidone must be administered by a healthcare professional, the medication can also be taken orally on a long-term basis. Currently, the effects or taking intra-muscular and oral Ziprasidone at the same time are unclear. Intra-muscular Ziprasidone is not, therefore, recommended for patients who are already taking the medication orally.

Due to the fast-acting nature of intra-muscular Ziprasidone, it is suitable for schizophrenic patients who are experiencing extreme or enhanced states of agitation. As agitation is commonly associated with schizophrenia, patients may require a medication review as part of their long-term treatment plan, particularly if periods of uncontrollable agitation occur frequently.

However, increased agitation and anxiety can be extremely distressing for the patient and acute care may, therefore, be required. Intra-muscular Ziprasidone is a suitable method of stabilizing the patient in the short-term and can enable them to return to a lucid state relatively quickly. As injections of Ziprasidone are administered into the patient's muscle, rather than subcutaneously, it takes effect more quickly than other similar medications. By reducing agitation and associated symptoms, intra-muscular Ziprasidone enables patients to think more clearly and exhibit calmer, more rational behaviors.

Conditions Treated:

  • Schizophrenia-related Agitation

Type of Medicine:

  • Atypical Antipsychotics

Side Effects:

Common side effects associated with Ziprasidone (intra-muscular) include cold sweats, confusion and headaches. In addition to this, patients may experience shaking or tremors, nausea or vomiting, dizziness and light-headedness. Often, these side effects can be reduced by laying down for a short time after the injection has been administered. Similarly, patients can reduce potential side effects by rising slowly to a sitting position, following a period of rest.

Generally, these side effects are mild or moderate in nature. Patients should advise their healthcare professional if side effects worsen or persist, however. Pain or swelling at the site of the injection is also not uncommon but should decrease fairly rapidly.

Although less common, feelings of anxiety or irritability may occur once the medication has been administered. Patients may also experience a tingling or burning sensation, along with loss of balance control, muscle stiffness, and tiredness.

In some patients, side effects may impact their digestive system and result in vomiting, a lack of appetite, diarrhea and bloody stools. Alternatively, patients may report feeling unwell, show signs of increased blood sugar or describe a general feeling of tiredness and discomfort. If the patient becomes particularly unwell or if symptoms worsen over time, physicians may decide to discontinue treatment.

Generally, mild side effects will decrease as the medication is processed by the body. Due to this, additional medication to treat the side effects of Ziprasidone is not usually needed. Despite this, side effects should be reported to the patient’s physician so that medical assistance can be provided, if deemed necessary.

In rare cases, however, more serious side effects may occur. Changes to the patient’s mental state or mood should be reported to a doctor immediately. These may include restlessness or a notable change in personality. Convulsions, uncontrollable actions, rapid tongue movements and difficulty breathing can be caused by Ziprasidone on rare occasions and, if patients are affected by these side effects, they should seek medical help immediately.

Neuroleptic Malignant Syndrome (NMS) is associated with all antipsychotic medications, including intra-muscular Ziprasidone. Although rare, NMS can cause hyperpyrexia, diaphoresis, tachycardia, cardiac dysrhythmia and an altered mental state. As NMS can be fatal, treatment of Ziprasidone should be discontinued immediately if the patient shows signs of the condition.

Similarly, if Severe Cutaneous Adverse Reactions (SCAR), Drug Reaction with Eosinophilia and System Symptoms (DRESS) or Stevens-Johnson Syndrome become apparent, treatment must be stopped immediately.

Following any instance of NMS, SCAR, DRESS or Stevens-Johnson Syndrome, patients should be monitored carefully and emergency treatment given, if required.

In some instances, patients may display an allergic reaction after receiving the medication. If the patient displays hives, blistering, sores, facial swelling and/or a fast or irregular heartbeat, the presence of an allergy should be investigated and treated.

Dosage:

Ziprasidone (intra-muscular) will be delivered by a doctor or alternative healthcare professional, in a hospital or clinical setting. They will, therefore, base the dosage on the patient’s weight and current level of agitation.

Standard doses vary from 10 to 20mg but less may be given if the patient’s level of agitation is relatively low. In most cases, the lowest possible dose of intra-muscular Ziprasidone should be given at the outset. Once efficacy and potential side effects have been determined, physicians may decide to administer further medication, if the patient is still displaying symptoms of agitation and anxiety.

Additional Ziprasidone can be administered via injection as required, but the total dosage should not exceed 40mg per day. Normally, 10mg can be given every two hours or 20mg administered every four hours, but this will depend on the patient’s weight and clinical presentation.

As intra-muscular Ziprasidone is considered to be a short-term solution, it is not normally used for a period exceeding three days. If the patient shows signs of ongoing schizophrenia-related agitation or anxiety, oral Ziprasidone can be given on a long-term basis.

Interactions:

As some drugs can interact with others, it’s essential that medical professionals are aware of any other medications you may be taking. Even drugs which haven’t been taken recently can remain in your system, so it’s important to inform your physician of your usual and current medication consumption.

As well as interacting with specific medications, Ziprasidone may have adverse effects if you are suffering from other medical conditions. A full medical history should be obtained prior to administering intra-muscular Ziprasidone. For further information regarding contra-indicators, see the Warnings section below.

Drugs with may interact with intra-muscular Ziprasidone include, but are not limited to:

  • Amiodarone (Nexterone, Pacerone, Cordarone)
  • Arsenic Trioxide (Trisenox)
  • Chlorpromazine
  • Disopyramide (Norpace)
  • Dofetilide (Tikosyn)
  • Dolasetron (Anzemet)
  • Dronedarone (Multaq)
  • Droperidol (Inapsine)
  • Gatifloxacin
  • Ibutilide (Corvert)
  • Halofantrine (Halfan)
  • Levomethadyl (ORLAAM)
  • Mefloquine
  • Mesoridazine
  • Moxifloxacin (Avelox)
  • Pentamidine (NebuPent, Pentam)
  • Pimozide (Orap)
  • Probucol
  • Procainamide
  • Quinidine (in Nuedexta)
  • Sotalol (Betapace, Sorine, Sotylize)
  • Sparfloxacin
  • Tacrolimus (Astagraf, Prograf)
  • Thioridazine

Due to the potential interactions of these medications with Ziprasidone, physicians may not prescribe intra-muscular injections as a form of treatment. Alternatively, other medications may be discontinued or altered if Ziprasidone is considered to be beneficial.

While the following medications may not prevent Ziprasidone from being prescribed, they may affect the dosage you’re given. By disclosing their current medications, patients can ensure that they receive an appropriate and therapeutic dose of intra-muscular Ziprasidone. As a result, you must inform your doctor if you’re currently taking:

  • Antidepressants
  • Carbamazepine (Carbatrol, Tegretol, Teril and others)
  • Antifungals, such as Ketoconazole (Extina, Nizoral)
  • Bromocriptine (Cycloset, Parlodel)
  • Cabergoline
  • Levodopa (in Sinemet)
  • Pergolide (Permax)
  • Ropinirole (Requip)
  • Any medications for mental illness, high blood pressure, anxiety or seizures
  • Any medications with sedative effects, such as anti-anxiety medications, sleeping tablets etc.

Warnings:

Prior to intra-muscular Ziprasidone being administered, patients should advise their physician of any existing health conditions they have been diagnosed with. Their current health and potentially undiagnosed conditions should also be taken into account when Ziprasidone is prescribed, as the medication could worsen symptoms.

As patients may be distressed or agitated prior to receiving Ziprasidone, it may be necessary for physicians to obtain a medical history from the patient’s notes or next of kin.

Due to the effects of this medication, caution should be used if the patient suffers from, or has a history of, heart failure. When the patient has a history of irregular heartbeat, also known as QT prolongation, myocardial infarction and cardiac arrest, it’s likely that physicians will choose not to administer Ziprasidone as it could have an impact on heart rhythm.

Other conditions may also affect the suitability of intra-muscular Ziprasidone. Patients should notify their doctor if they have experienced any of the following: stroke or TIA, difficulty swallowing, high cholesterol levels (dyslipidemia), balance problems, low white blood cell count, breast cancer and heart, liver or kidney disease.

Women who are pregnant or are planning to become pregnant should inform their doctor before intra-muscular Ziprasidone is prescribed. If administered during the third-trimester of pregnancy, neonates are at risk of suffering extrapyramidal and/or withdrawal symptoms. Due to this, intra-muscular Ziprasidone should only be given to pregnant patients if the benefits clearly outweigh the risks associated with the drug. For patients who are breastfeeding or nursing, the use of intra-muscular Ziprasidone is not usually recommended.

As Ziprasidone can affect the way in which a patient thinks, it’s important that doctors are aware of any previous suicidal thoughts or suicide attempts. Similarly, patients should tell their physician if they have considered harming themselves or have attempted to hurt themselves. While intra-muscular Ziprasidone can still be given to patients with a history of suicidal ideation, physicians can arrange for additional monitoring to take place, if they are aware of the patient’s history.

Patients are advised to inform their physician if they have ever used recreational drugs or have exceeded the recommended dose of prescribed or over-the-counter medications.

In some cases, low levels of potassium or magnesium may prevent intra-muscular Ziprasidone from being prescribed. If possible, physicians should attempt to correct electrolyte levels before embarking on Ziprasidone treatment. As Ziprasidone is often required in urgent settings, however, it may be appropriate for doctors to monitor and rebalance electrolyte levels once Ziprasidone has been administered.

Ziprasidone can cause an increase in blood sugar levels (hyperglycemia) and should, therefore, be used cautiously in patients with diabetes. Regular testing of blood sugar levels can help to identify an increase of blood sugar and should be carried out if intra-muscular Ziprasidone is prescribed to diabetic patients. If patients experience side-effects, such as dry mouth, increased urination, blurred vision, extreme hunger and/or weakness, ketoacidosis may occur due to an increase in blood sugar. As ketoacidosis is potentially life-threatening, patients should inform their healthcare practitioner of these side-effects immediately.

Due to the sedative effect of Ziprasidone, patients may feel drowsy after receiving the medication. As a result, patients should refrain from driving, using heavy machinery or consuming alcohol until the effects of the medication have worn off.

This medication can make it difficult for the body to cool down, particularly in very hot environments. Patients are, therefore, advised to refrain from vigorous exercise or significant heat unless this has been discussed with their physician.

Although the use of intra-muscular Ziprasidone has been associated with the treatment of dementia in elderly patients, it is not recommended or approved for this use. Studies have shown that the use of antipsychotics in treating older patients with dementia-induced psychosis has an increased risk of death and Ziprasidone should never be administered to patients falling within this risk category.

As intra-muscular Ziprasidone is administered in a clinical setting by a registered medical professional, overdose is rare.

If too much medication has been given, however, patients may experience drowsiness, slurred speech, anxiety, uncontrollable movements and high levels of anxiety. In instances of overdose, emergency action must be taken if the patient collapses or stops breathing. In addition to this, it is advisable to contact a Poison Control Center on 1-800-222-1222.

Storage

Prior to being administered, Ziprasidone powder must be mixed with water so that it can be injected. Ziprasidone powder can be stored indefinitely at temperatures between 59° and 86°F, although a temperature of 77°F is optimal. Powder should be kept in dry form and protected from the light.

Intra-muscular Ziprasidone can be prepared and reconstituted in advance, so that it is ready to be administered via injection, as and when it is needed. Once the solution has been prepared, it can be stored for up to 24 hours at 59°-86°F, providing it is protected from the light. Alternatively, a prepared solution can be stored for up to seven days in a refrigerated environment of 36°-46°F.

When preparing the solution, aseptic technique must be used as the product does not contain a preservative or bacteriostatic agent.

When intra-muscular Ziprasidone is prescribed, it must be administered by a healthcare practitioner. Due to this, patients will not be required to store the medication at home.

Summary

Although intra-muscular Ziprasidone can be extremely effective in reducing schizophrenic-related agitation, additional care must be taken when prescribing this medication. Like any pharmaceutical, Ziprasidone can interact with other medications and may, in some cases, worsen existing conditions.

As patients may be in a state of distress prior to intra-muscular Ziprasidone being administered, it’s vital that physicians are able to obtain an accurate medical history before prescribing the medication. If the patient is unable to interact with physicians effectively, their medical information may need to be accessed via another source.

While intra-muscular Ziprasidone is not a long-term treatment for agitation, it can be ideal when used in instances of mental health crisis. When patients are in a state of schizophrenia induced agitation, they may present as highly distressed. Additionally, physicians may feel that their current state renders them a danger to themselves or others.

Due to the potential side-effects and interactions of Ziprasidone, doctors may be required to determine whether the benefit of the drug outweighs the risk it poses, particularly if the patient is displaying one or more contra-indicators. If patients are able to liaise with doctors, these concerns should be discussed before the injection is given.

As many patients receiving intra-muscular Ziprasidone will do so in an inpatient hospital setting, physicians should be able to monitor their response to the drug regularly. In addition to assessing the patient’s clinical presentation, blood tests can be taken to identify any unwanted or potentially dangerous physiological reactions.

Although intra-muscular Ziprasidone is only approved for use in limited circumstances, it is an appropriate course of treatment for certain patients. By administering intra-muscular Ziprasidone, physicians can relieve feelings of agitation, discomfort, and anxiety quickly and return the patient to a more relaxed, calm state.

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Last Reviewed:
December 23, 2017
Last Updated:
December 22, 2017
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