Ziprasidone: first year experience in a hospital setting.
BACKGROUND
The antipsychotic drug ziprasidone, FDA-approved and introduced in the United States in February 2001 for the treatment of schizophrenia, appears to have similar efficacy but better tolerability than older antipsychotics and requires further evaluation under clinical conditions.


METHODS
We analyzed medical records of McLean Hospital inpatients treated with ziprasidone between March 2001 and February 2002, gathering data on DSM-IV diagnoses, presenting symptoms, dosing, concomitant psychotropic medications, clinical changes, adverse effects, and electrocardiographic (ECG) findings.


RESULTS
Ziprasidone was given to 151 inpatients (3.4% of admissions; 108 women, 43 men), aged 37.5 +/- 11.4 years, who presented with depression (n = 79), psychosis (n = 46), mania (n = 18), bipolar mixed-states (n = 4), or other conditions (n = 4). Daily doses averaged 49.8 +/- 34.1 mg initially and 83.2 +/- 46.3 mg at discharge; the greatest dose increases during hospitalization (by a mean of 61%) were in patients with schizoaffective disorder (n = 46; 30% of cases). In 41 cases (27%), ziprasidone was the only antipsychotic at discharge; in 61 (40%) it was used with other antipsychotics. Ziprasidone was discontinued during hospitalization in 49 cases (32.5%), due to lack of efficacy (n = 26; 17.2%), adverse effects (n = 13, 8.6%), or reasons not stated (n = 10, 6.6%). Of 70 patients for whom ECG data were obtained during treatment with ziprasidone, 8 (11%) had QTc intervals > 450 msec during treatment, but none of the 39 patients with ECGs both before and during ziprasidone treatment showed clinically meaningful increases in QTc intervals. Ziprasidone was discontinued in 4 patients (2.6%) due to concern about QTc intervals, but in no case was the QTc interval > or = 500 msec or associated with clinical cardiac toxicity. Improvements in CGI and GAF scores from admission to discharge were similar across diagnoses and unrelated to length of stay or ziprasidone dose.


CONCLUSIONS
Ziprasidone was well tolerated by hospitalized patients with various major psychiatric disorders and may be of value in conditions other than schizophrenia.
Centorrino
Franca
F
Schizophrenia & Bipolar Disorder Clinic, McLean Hospital, Belmont, MA 02478-9106, USA.
MacLean
Elizabeth
E
Salvatore
Paola
P
Kidwell
Jennifer E
JE
Fogarty
Kate V
KV
Berry
Judith M
JM
Baldessarini
Ross J
RJ
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy*; D004562:Electrocardiography; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008133:Long QT Syndrome / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000188:drug therapy; D010879:Piperazines / Q000009:adverse effects* / Q000627:therapeutic use*; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy*; D013844:Thiazoles / Q000009:adverse effects* / Q000627:therapeutic use*; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D010879:Piperazines; D013844:Thiazoles; C092292:ziprasidone