The tolerability of intramuscular ziprasidone and haloperidol treatment and the transition to oral therapy

Abstract

The intramuscular (i.m.) formulation of ziprasidone offers promise as an alternative to conventional i.m. agents for the short-term management of agitated patients with psychosis. This 7-day, randomized, open-label study evaluated the tolerability of ziprasidone i.m. and haloperidol i.m. in hospitalized patients with a psychotic disorder and moderate psychopathology. Patients received three fixed doses of ziprasidone i.m. 5 mg qid (n=69), 10mg qid (currently maximum recommended daily dose in USA; n=71), 20mg qid (n=66), or flexible-dose/ flexible-schedule haloperidol i.m. up to 10 mg bid-qid (n=100) for 3 days. This was followed by oral treatment with the same medication for 4 days. Ziprasidone i.m. was associated with a notably lower burden of movement disorders than haloperidol i.m. (mean 11 mg/day). No bradycardia, sinus pauses, disinhibition, confusion, excessive sedation or respiratory depression was observed with ziprasidone. No safety issues were identified with the coadministration of lorazepam with the i.m. formulations of either agent. All three ziprasidone i.m. doses and haloperidol i.m. maintained control of symptoms and, following the transition to oral treatment, symptoms remained controlled. Ziprasidone i.m. 5,10, and 20 mg qid, given for 3 days were well tolerated. The transition from i.m. to oral ziprasidone was well tolerated with continuing maintenance of symptom control.

Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone

“…10,37 Moreover, other studies have not consistently demonstrated the superior efficacy of SGA compared to haloperidol alone. 35,[38][39][40] Our results demonstrated that olanzapine required fewer additional medications, which was different from the results of the TREC study. 4 Some clinical trials among patients with acute agitation associated with schizophrenia have demonstrated that the IM formulations of atypical antipsychotics provide similar efficacy to those of conventional antipsychotics, albeit without the associated high incidence of extra-pyramidal side effects (EPS).…”

Intramuscular Ziprasidone Versus Haloperidol for Managing Agitation in Chinese Patients With Schizophrenia

“…The ziprasidone group also demonstrated similar safety and superior tolerability compared to the haloperidol group, consistent with other pivotal studies comparing IM ziprasidone and IM haloperidol. 9,11 One earlier international, randomized, open-label study compared the efficacy and tolerability of ziprasidone IM and haloperidol IM in hospitalized subjects with acute exacerbation of schizophrenia or schizoaffective disorder. 9 During the first 3 days of this study, subjects received a flexible IM dose of either ziprasidone (10 or 20 mg initial dose, 40 mg maximum per day) or haloperidol (2.5 or 5 mg initial dose, 10 mg maximum per day).…”

Management of acute agitation in psychosis: an evidence-based approach in the USA

“…Haloperidol has demonstrated increased rates of events involving extra pyramidal side-effects in transition compared with aripiprazole and ziprasidone and it frequently requires concomitant administration of anticholinergic medications (Daniel 2004;Citrome 2007). One of the major benefits of using the more expensive atypical antipsychotics is the obviation of anticholinergic use both prophylactically and acutely (Raja 2001).…”