ZIPRASIDONE HYDROCHLORIDE
(zip-ra-si′done)
Geodon Classification: ATYPICAL ANTIPSYCHOTIC
Therapeutic: ANTIPSYCHOTIC
Prototype: Clozapine Pregnancy
Category: C
AVAILABILITY
Capsule; solution for injection
ACTION & THERAPEUTIC EFFECT
Exerts antischizophrenic effects through dopamine (D2) and serotonin (5-HT2A) receptor antagonism. Exerts antidepressant effects through 5-HT1A agonism, 5-HT1D antagonism, and serotonin/ norepinephrine reuptake inhibition. Improves signs and symptoms of schizophrenia, schizoaffective disorder, and psychotic depression.
USES
Treatment of schizophrenia, acute bipolar mania, acute psychosis, agitation.
UNLABELED USES
Tourette’s syndrome.
CONTRAINDICATIONS
Hypersensitivity to ziprasidone; history of QT prolongation including congenital long QT syndrome or with other drugs known to prolong the QT interval; AV block, bundle branch block, cardiac arrhythmias, congenital heart disease, recent MI or uncompensated heart failure; bradycardia, hypokalemia or hypomagnesemia; neuroleptic malignant syndrome and tardive dyskinesia; dehydration or hypovolemia; UV exposure and tanning beds; older adults with dementia-related psychosis; lactation.
CAUTIOUS USE
History of seizures, CVA, dementia, Parkinson’s disease, or Alzheimer disease; known cardiovascular disease, conduction abnormalities, cerebrovascular disease; hepatic impairment; seizure disorder, seizures; breast cancer; risk factors for elevated core body temperature; esophageal motility disorders and risk of aspiration pneumonia; schizophrenia; suicide potential; pregnancy (category C); children older than 7 y for use in Tourette’s syndrome only. Safety and efficacy in children or adolescents (except for treatment of Tourette’s syndrome) are not established.
ROUTE & DOSAGE
Schizophrenia
Adult: PO Start with 20 mg b.i.d. with food, may increase q2days up to 80 mg b.i.d. if needed
Acute Episodes of Agitation/ Acute Psychosis
Adult: IM 10 mg q2h or 20 mg q4h up to max of 40 mg/day
Acute Mania/Bipolar Disorder
Adult: PO Start with 40 mg b.i.d. with food; may increase q2days up to 80 mg b.i.d. if needed
- Give deep IM into a large muscle.
- Store at 15°–30° C (59°–86° F).
ADVERSE EFFECTS
(≥1%) Body as a Whole: Asthenia, myalgia, weight gain, flu-like syndrome, face edema, chills, hypothermia. CNS: Somnolence, akathisia, dizziness, extrapyramidal effects, dystonia, hypertonia, agitation, tremor, dyskinesias, hostility, paresthesia, confusion, vertigo, hypokinesia, hyperkinesias, abnormal gait, oculogyric crisis, hypesthesia, ataxia, amnesia, cogwheel rigidity, delirium, hypotonia, akinesia, dysarthria, withdrawal syndrome, buccoglossal syndrome, choreoathetosis, diplopia, incoordination, neuropathy. CV: Tachycardia, postural hypotension, prolonged QTc interval, hypertension. GI: Nausea, constipation, dyspepsia, diarrhea, dry mouth, anorexia, abdominal pain, vomiting. Metabolic: Hyperglycemia, diabetes mellitus. Respiratory: Rhinitis, increased cough, dyspnea. Skin: Rash, fungal dermatitis, photosensitivity. Special Senses: Abnormal vision.
INTERACTIONS
Drug: Carbamazepine may decrease ziprasidone levels; ketoconazole may increase ziprasidone levels; may enhance hypotensive effects of ANTIHYPERTENSIVE AGENTS; may antagonize effects of levodopa; increased risk of arrhythmias and heart block due to prolonged QTc interval with ANTIARRHYTHMIC AGENTS, amoxapine, arsenic trioxide, chlorpromazine, clarithromycin, daunorubicin, diltiazem, dolasetron, doxorubicin, droperidol, erythromycin, halofantrine, indapamide, levomethadyl, LOCAL ANESTHETICS, maprotiline, mefloquine, mesoridazine, octreotide, pentamidine, pimozide, probucol, gatifloxacin, grepafloxacin, levofloxacin, moxifloxacin, sparfloxacin, TRICYCLIC ANTIDEPRESSANTS,tacrolimus, thioridazine, troleandomycin; additive CNS depression with SEDATIVE- HYPNOTICS, ANXIOLYTICS, ethanol, OPIATE AGONISTS.
PHARMACOKINETICS
Absorption: Well absorbed with 60% reaching systemic circulation. Peak: 6–8 h. Metabolism: In liver (CYP3A4). Elimination: Feces and urine. Half-Life: 7 h.
NURSING IMPLICATIONS
Black Box Warning
Ziprasidone has been associated with increased mortality in older adults with dementia-related psychosis.
Assessment & Drug Effects
- Monitor diabetics for loss of glycemic control.
- Monitor for S&S of torsade de pointes (e.g., dizziness, palpitations, syncope), tardive dyskinesia (see Appendix F) especially in older adult women and with prolonged therapy, and the appearance of an unexplained rash. Withhold drug and report to prescriber immediately if any of these develop.
- Monitor for signs and symptoms of suicidality.
- Monitor I&O ratio and pattern: Notify prescriber if diarrhea, vomiting or any other conditions develops which may cause electrolyte imbalance.
- Monitor BP lying, sitting, and standing. Report orthostatic hypotension to prescriber.
- Monitor cognitive status and take appropriate precautions.
- Monitor for loss of seizure control, especially with a history of seizures or dementia.
- Montior lab tests: Baseline and periodic ECG, serum potassium and serum magnesium, especially with concomitant diuretic therapy; periodic blood glucose.
Patient & Family Education
- Carefully monitor blood glucose levels if diabetic.
- Be aware that therapeutic effect may not be evident for several weeks.
- Report any of the following to a health care provider immediately: Palpitations, faintness or loss of consciousness, rash, abnormal muscle movements, vomiting or diarrhea.
- Do not drive or engage in potentially hazardous activities until response to drug is known.
- Make position changes slowly and in stages to prevent dizziness upon arising.
- Avoid strenuous exercise, exposure to extreme heat, or other activities that may cause dehydration.
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