Ziprasidone

From Wikipedia, the free encyclopedia - View original article

Ziprasidone
Systematic (IUPAC) name
5-[2-[4-(1,2-benzisothiazol-3-yl)-1-piperazinyl]ethyl]-6-chloro-1,3-dihydro-2H-indol-2-one
Clinical data
Trade namesGeodon
AHFS/Drugs.commonograph
MedlinePlusa699062
Licence dataUS FDA:link
Pregnancy cat.C (US)
Legal status Prescription only
RoutesOral, IM
Pharmacokinetic data
Bioavailability60% (oral)
100% (IM)
Metabolismhepatic (aldehyde reductase)
Half-life7 hours
ExcretionUrine and feces
Identifiers
CAS number146939-27-7 YesY
ATC codeN05AE04
PubChemCID 60854
IUPHAR ligand59
DrugBankDB00246
ChemSpider54841 YesY
UNII6UKA5VEJ6X YesY
KEGGD08687 YesY
ChEBICHEBI:10119 YesY
ChEMBLCHEMBL708 YesY
Chemical data
FormulaC21H21ClN4OS 
Mol. mass412.936 g/mol
 YesY (what is this?)  (verify)
 
  (Redirected from Geodon)
Jump to: navigation, search
Ziprasidone
Systematic (IUPAC) name
5-[2-[4-(1,2-benzisothiazol-3-yl)-1-piperazinyl]ethyl]-6-chloro-1,3-dihydro-2H-indol-2-one
Clinical data
Trade namesGeodon
AHFS/Drugs.commonograph
MedlinePlusa699062
Licence dataUS FDA:link
Pregnancy cat.C (US)
Legal status Prescription only
RoutesOral, IM
Pharmacokinetic data
Bioavailability60% (oral)
100% (IM)
Metabolismhepatic (aldehyde reductase)
Half-life7 hours
ExcretionUrine and feces
Identifiers
CAS number146939-27-7 YesY
ATC codeN05AE04
PubChemCID 60854
IUPHAR ligand59
DrugBankDB00246
ChemSpider54841 YesY
UNII6UKA5VEJ6X YesY
KEGGD08687 YesY
ChEBICHEBI:10119 YesY
ChEMBLCHEMBL708 YesY
Chemical data
FormulaC21H21ClN4OS 
Mol. mass412.936 g/mol
 YesY (what is this?)  (verify)

Ziprasidone (marketed as Geodon, Zeldox by Pfizer) was the fifth atypical antipsychotic to gain approval (February 2001) in the United States. It is approved by the U.S. Food and Drug Administration (FDA) for the treatment of schizophrenia, and acute mania and mixed states associated with bipolar disorder. Its intramuscular injection form is approved for acute agitation in schizophrenic patients for whom treatment with just ziprasidone is appropriate.[1]

Ziprasidone is also used off-label for depression, bipolar maintenance, mood disorders, anxiety, aggression, dementia, attention deficit hyperactivity disorder, obsessive compulsive disorder, autism, and post-traumatic stress disorder, though Pfizer was penalized for promoting such uses in US.[1] The brand name Geodon has been suggested to bring to mind the phrase 'down (don) to earth (geo)' referring to the goals of the medication.[citation needed]

The oral form of ziprasidone is the hydrochloride salt, ziprasidone hydrochloride. The intramuscular form, on the other hand, is the mesylate salt, ziprasidone mesylate trihydrate, and is provided as a lyophilized powder.

Geodon was one of four drugs which Pfizer pleaded guilty to misbranding "with the intent to defraud or mislead" in 2009 as a result of a qui tam lawsuit by Stefan P. Kruszewski. Pfizer was found to have illegally promoted four of its drugs for (legal) use in conditions that had not been approved by the FDA. Pfizer agreed to pay $2.3 billion (£1.4 billion) in settlement, and entered a corporate integrity agreement.[2]

Contents

Pharmacology

Binding profile

Ziprasidone acts as an antagonist/inverse agonist (unless otherwise noted) of the following receptors and transporters:[3][4][5][6]

Correspondance to clinical effects

Ziprasidone's affinities for most of the dopamine and serotonin receptors and the α1-adrenergic receptor are high and its affinity for the histamine H1 receptor is moderate.[3][11] It also displays some inhibition of synaptic reuptake of serotonin and norepinephrine, though not dopamine.[3][12]

Ziprasidone's efficacy in treating the positive symptoms of schizophrenia is believed to be mediated primarily via antagonism of the dopamine receptors, specifically D2. Blockade of the 5-HT2A receptor may also play a role in its effectiveness against positive symptoms, though the significance of this property in antipsychotic drugs is still debated among researchers.[13] Blockade of 5-HT2A and 5-HT2C and activation of 5-HT1A as well as inhibition of the reuptake of serotonin and norepinephrine may all contribute to its ability to alleviate negative symptoms.[14] The relatively weak antagonistic actions of ziprasidone on the α1-adrenergic and H1 receptors likely in part explain some of its side effects, such as sedation and orthostatic hypotension. Unlike many other antipsychotics, ziprasidone has no significant affinity for the mACh receptors, and as such lacks any anticholinergic side effects.

Pharmacokinetics

The systemic bioavailability of ziprasidone administered intramuscularly is 100%, or 60%, administered orally with food. After a single dose intramuscular administration, the peak serum concentration typically occurs at about 60 minutes after the dose is administered, or earlier. Steady state plasma concentrations are achieved within one to three days. The mean half-life ranges from two to five hours. Exposure increases in a dose-related manner and following three days of intramuscular dosing, little accumulation is observed.

Ziprasidone absorption is optimally achieved when administered with food. Without a meal preceding dose, the bioavailability of the drug is reduced by approximately 50%.[15][16]

Ziprasidone is hepatically metabolized by aldehyde oxidase; minor metabolism occurs via cytochrome P450 3A4 (CYP3A4).[17] Medications that induce (e.g. carbamazepine) or inhibit (e.g. ketoconazole) CYP3A4 have been shown to decrease and increase, respectively, blood levels of ziprasidone.[18][19]

Adverse effects

Ziprasidone received a black box warning due to increased mortality in elderly patients with dementia-related psychosis.[15] It also slightly increases the QTc interval in some patients and increases the risk of a potentially lethal type of heart arrhythmia known as torsades de pointes. Ziprasidone should be used cautiously in patients taking other medications likely to interact with ziprasidone or increase the QTc interval.[20]

Ziprasidone is known to cause activation into mania in some bipolar patients.[21][22][23]

This medication can cause birth defects, according to animal studies, although this side effect has not been confirmed in humans.[15]

Adverse events reported for ziprasidone include severe chest pains, impaired erectile function and stimulation, sedation, insomnia, orthostatic hypotension, life-threatening neuroleptic malignant syndrome, akathisia, and the development of permanent neurological disorder tardive dyskinesia. Rarely, temporary speech disorders may result.

Recently, the FDA required the manufacturers of some atypical antipsychotics to include a warning about the risk of hyperglycemia and Type II diabetes with atypical antipsychotics. Some evidence suggests that ziprasidone may not be as bad as some of the other atypical antipsychotics (namely, olanzapine (Zyprexa)) at causing insulin resistance and weight gain.[24][25][26][27] In fact, in a trial of long term therapy with ziprasidone, overweight patients (BMI > 27) actually had a mean weight loss overall.[15] However, ziprasidone is not a weight loss drug. The weight loss reflected in this study on ziprasidone was really reflective of patients who had gained weight on other antipsychotics who were now trending back toward their baseline.[citation needed] According to the manufacturer insert , ziprasidone caused an average weight gain of 2.2 kg (4.8 lbs) (which is significantly lower than other atypicals–clozapine and olanzapine).

Discontinuation

Ziprasidone should be discontinued gradually, with careful consideration from the prescribing doctor, to avoid withdrawal symptoms or relapse. Withdrawal may become even more difficult after failed attempts.[citation needed]

The British National Formulary recommends a gradual withdrawal when discontinuing anti-psychotic treatment to avoid acute withdrawal syndrome or rapid relapse.[28] Due to compensatory changes at dopamine, serotonin, adrenergic and histamine receptor sites in the central nervous system, withdrawal symptoms can occur during abrupt or over-rapid reduction in dosage.

However, despite increasing demand for safe and effective antipsychotic withdrawal protocols or dose-reduction schedules, no specific guidelines with proven safety and efficacy are currently available. Some have suggested using The Ashton Manual, originally developed for benzodiazapine withdrawal. Support groups such as The Icarus Project and other online forums provide resources and social support for those attempting to discontinue antipsychotics and other psychiatric medications.[29] Withdrawal symptoms reported to occur after discontinuation of antipsychotics include nausea, emesis, lightheadedness, diaphoresis, dyskinesia, orthostatic hypotension, tachycardia, nervousness, dizziness, headache, excessive non-stop crying, and anxiety.[30][31] Some have argued that additional somatic and psychiatric symptoms associated with dopaminergic super-sensitivity, including dyskinesia and acute psychosis, are common features of withdrawal in individuals treated with neuroleptics.[32][33][34][35] This has led some to suggest that the withdrawal process might itself be schizo-mimetic, producing schizophrenia-like symptoms even in previously healthy patients, indicating a possible pharmacological origin of mental illness in a yet unknown percentage of patients currently and previously treated with antipsychotics. This question is unresolved, and remains a highly controversial issue among professionals in the medical and mental health communities, as well the public.[36] Complicated and long-lasting rebound insomnia symptoms can also occur after withdrawing from antipsychotics.[37]

Overdose

Ziprasidone doses as large as 3,240 mg have been "survived without sequelae." The most common effects reported by Pfizer include extrapyramidal reactions, somnolence, tremor, and anxiety.

References

  1. ^ a b "Pfizer to pay $2.3 billion to resolve criminal and civil health care liability relating to fraudulent marketing and the payment of kickbacks". Stop Medicare Fraud, US Dept of Health & Human Svc, and of US Dept of Justice. http://www.stopmedicarefraud.gov/pfizerfactsheet.html. Retrieved 2012-07-04. 
  2. ^ "Pfizer agrees record fraud fine". BBC News. British Broadcasting Corporation. 2 September 2009. http://news.bbc.co.uk/2/hi/business/8234533.stm. 
  3. ^ a b c Hagop S. Akiskal; Mauricio Tohen (24 June 2011). Bipolar Psychopharmacotherapy: Caring for the Patient. John Wiley & Sons. p. 209. ISBN 978-1-119-95664-8. http://books.google.com/books?id=u0fO8RRIE1MC&pg=PT209. Retrieved 13 May 2012. 
  4. ^ Seeger TF, Seymour PA, Schmidt AW, et al. (October 1995). "Ziprasidone (CP-88,059): a new antipsychotic with combined dopamine and serotonin receptor antagonist activity". The Journal of Pharmacology and Experimental Therapeutics 275 (1): 101–13. PMID 7562537. http://jpet.aspetjournals.org/cgi/pmidlookup?view=long&pmid=7562537. 
  5. ^ Schotte A, Janssen PF, Gommeren W, et al. (March 1996). "Risperidone compared with new and reference antipsychotic drugs: in vitro and in vivo receptor binding". Psychopharmacology 124 (1-2): 57–73. PMID 8935801. http://link.springer.de/link/service/journals/00213/bibs/61241-2/61240057.htm. 
  6. ^ a b PDSP certified data
  7. ^ Newman-Tancredi A, Gavaudan S, Conte C, et al. (August 1998). "Agonist and antagonist actions of antipsychotic agents at 5-HT1A receptors: a [35SGTPgammaS binding study"]. European Journal of Pharmacology 355 (2-3): 245–56. doi:10.1016/S0014-2999(98)00483-X. PMID 9760039. http://linkinghub.elsevier.com/retrieve/pii/S0014-2999(98)00483-X. 
  8. ^ Roland Seifert; Thomas Wieland; Raimund Mannhold; Hugo Kubinyi, Gerd Folkers (17 July 2006). G Protein-Coupled Receptors as Drug Targets: Analysis of Activation and Constitutive Activity. John Wiley & Sons. p. 227. ISBN 978-3-527-60695-5. http://books.google.com/books?id=pIrnOKH-7HcC&pg=PA227. Retrieved 13 May 2012. 
  9. ^ Wood MD, Scott C, Clarke K, et al. (August 2006). "Pharmacological profile of antipsychotics at monoamine receptors: atypicality beyond 5-HT2A receptor blockade". CNS & Neurological Disorders Drug Targets 5 (4): 445–52. PMID 16918396. http://www.benthamdirect.org/pages/content.php?CNSNDDT/2006/00000005/00000004/0009Z.SGM. 
  10. ^ a b Daniel DG, Zimbroff DL, Potkin SG, Reeves KR, Harrigan EP, Lakshminarayanan M (May 1999). "Ziprasidone 80 mg/day and 160 mg/day in the acute exacerbation of schizophrenia and schizoaffective disorder: a 6-week placebo-controlled trial. Ziprasidone Study Group". Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology 20 (5): 491–505. doi:10.1016/S0893-133X(98)00090-6. PMID 10192829. http://dx.doi.org/10.1016/S0893-133X(98)00090-6. 
  11. ^ Nemeroff CB, Lieberman JA, Weiden PJ, et al. (November 2005). "From clinical research to clinical practice: a 4-year review of ziprasidone". CNS Spectrums 10 (11 Suppl 17): 1–20. PMID 16381088. http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=403. 
  12. ^ Tatsumi M, Jansen K, Blakely RD, Richelson E (March 1999). "Pharmacological profile of neuroleptics at human monoamine transporters". European Journal of Pharmacology 368 (2-3): 277–83. doi:10.1016/S0014-2999(99)00005-9. PMID 10193665. 
  13. ^ Heinz Lüllmann; Klaus Mohr (2006). Pharmakologie und Toxikologie: Arzneimittelwirkungen verstehen- Medikamente gezielt einsetzen; ein Lehrbuch für Studierende der Medizin, der Pharmazie und der Biowissenschaften, eine Informationsquelle für Ärzte, Apotheker und Gesundheitspolitiker. Georg Thieme Verlag. ISBN 978-3-13-368516-0. http://books.google.com/books?id=7ewS8QAClYEC&pg=PP1. Retrieved 13 May 2012. 
  14. ^ Alan F. Schatzberg; Charles B. Nemeroff (10 February 2006). Essentials of Clinical Psychopharmacology. American Psychiatric Pub. p. 297. ISBN 978-1-58562-243-6. http://books.google.com/books?id=i5zrVD1PAwEC&pg=PA297. Retrieved 13 May 2012. 
  15. ^ a b c d "Geodon Prescribing Information". Pfizer, Inc.. http://www.pfizer.com/pfizer/download/uspi_geodon.pdf. Retrieved 2009-01-26. 
  16. ^ Miceli JJ, Glue P, Alderman J, Wilner K (2007). "The effect of food on the absorption of oral ziprasidone". Psychopharmacology Bulletin 40 (3): 58–68. PMID 18007569. 
  17. ^ Sandson NB, Armstrong SC, Cozza KL (2005). "An overview of psychotropic drug-drug interactions". Psychosomatics 46 (5): 464–94. doi:10.1176/appi.psy.46.5.464. PMID 16145193. 
  18. ^ Miceli JJ, Anziano RJ, Robarge L, Hansen RA, Laurent A (2000). "The effect of carbamazepine on the steady-state pharmacokinetics of ziprasidone in healthy volunteers". British Journal of Clinical Pharmacology 49 Suppl 1: 65S–70S. PMC 2015057. PMID 10771457. http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0306-5251&date=2000&volume=49&issue=&spage=65S. 
  19. ^ Miceli JJ, Smith M, Robarge L, Morse T, Laurent A (2000). "The effects of ketoconazole on ziprasidone pharmacokinetics--a placebo-controlled crossover study in healthy volunteers". British Journal of Clinical Pharmacology 49 Suppl 1: 71S–76S. PMC 2015056. PMID 10771458. http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0306-5251&date=2000&volume=49&issue=&spage=71S. 
  20. ^ Pfizer. "Geodon (ziprasidone HCl) Dear Healthcare Professional Letter, Mar 2002". MedWatch. Food and Drug Administration. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm170899.htm. Retrieved 2009-08-03. 
  21. ^ Baldassano CF, Ballas C, Datto SM, et al. (February 2003). "Ziprasidone-associated mania: a case series and review of the mechanism". Bipolar Disorders 5 (1): 72–5. PMID 12656943. http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1398-5647&date=2003&volume=5&issue=1&spage=72. 
  22. ^ Keating AM, Aoun SL, Dean CE (2005). "Ziprasidone-associated mania: a review and report of 2 additional cases". Clinical Neuropharmacology 28 (2): 83–6. PMID 15795551. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0362-5664&volume=28&issue=2&spage=83. 
  23. ^ Davis R, Risch SC (April 2002). "Ziprasidone induction of hypomania in depression?". The American Journal of Psychiatry 159 (4): 673–4. PMID 11925314. http://ajp.psychiatryonline.org/article.aspx?volume=159&page=673. 
  24. ^ Tschoner A, Engl J, Rettenbacher M, et al. (January 2009). "Effects of six second generation antipsychotics on body weight and metabolism - risk assessment and results from a prospective study". Pharmacopsychiatry 42 (1): 29–34. doi:10.1055/s-0028-1100425. PMID 19153944. http://www.thieme-connect.com/DOI/DOI?10.1055/s-0028-1100425. 
  25. ^ Guo JJ, Keck PE, Corey-Lisle PK, et al. (January 2007). "Risk of diabetes mellitus associated with atypical antipsychotic use among Medicaid patients with bipolar disorder: a nested case-control study". Pharmacotherapy 27 (1): 27–35. doi:10.1592/phco.27.1.27. PMID 17192159. http://dx.doi.org/10.1592/phco.27.1.27. 
  26. ^ Sacher J, Mossaheb N, Spindelegger C, et al. (June 2008). "Effects of olanzapine and ziprasidone on glucose tolerance in healthy volunteers". Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology 33 (7): 1633–41. doi:10.1038/sj.npp.1301541. PMID 17712347. http://dx.doi.org/10.1038/sj.npp.1301541. 
  27. ^ Newcomer JW (2005). "Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review". CNS Drugs 19 Suppl 1: 1–93. PMID 15998156. http://content.wkhealth.com/linkback/openurl?issn=1172-7047&volume=19&issue=&spage=1. 
  28. ^ Group, BMJ, ed. (March 2009). "4.2.1". British National Formulary (57 ed.). United Kingdom: Royal Pharmaceutical Society of Great Britain. p. 192. ISBN 0260-535X. "Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse." 
  29. ^ Coming off psych drugs at The Icarus Project
  30. ^ Kim, DR.; Staab, JP. (May 2005). "Quetiapine discontinuation syndrome". Am J Psychiatry 162 (5): 1020. doi:10.1176/appi.ajp.162.5.1020. PMID 15863814. http://ajp.psychiatryonline.org/cgi/content/full/162/5/1020. 
  31. ^ Michaelides, C.; Thakore-James, M.; Durso, R. (Jun 2005). "Reversible withdrawal dyskinesia associated with quetiapine". Mov Disord 20 (6): 769–70. doi:10.1002/mds.20427. PMID 15747370. 
  32. ^ Chouinard, G.; Jones, BD. (Jan 1980). "Neuroleptic-induced supersensitivity psychosis: clinical and pharmacologic characteristics". Am J Psychiatry 137 (1): 16–21. PMID 6101522. http://ajp.psychiatryonline.org/article.aspx?articleid=157922. 
  33. ^ Miller, R.; Chouinard, G. (Nov 1993). "Loss of striatal cholinergic neurons as a basis for tardive and L-dopa-induced dyskinesias, neuroleptic-induced supersensitivity psychosis and refractory schizophrenia". Biol Psychiatry 34 (10): 713–38. PMID 7904833. http://www.biologicalpsychiatryjournal.com/article/0006-3223(93)90044-E/abstract. 
  34. ^ Chouinard, G.; Jones, BD.; Annable, L. (Nov 1978). "Neuroleptic-induced supersensitivity psychosis". Am J Psychiatry 135 (11): 1409–10. PMID 30291. http://ajp.psychiatryonline.org/article.aspx?articleid=156959. 
  35. ^ Seeman, P.; Weinshenker, D.; Quiron, R.; Srivastava, LK.; Bhardwaj, SK.; Grandy, DK.; Premont, RT.; Sotnikova, TD. et al. (Mar 2005). "Dopamine supersensitivity correlates with D2High states, implying many paths to psychosis". Proc Natl Acad Sci U S A 102 (9): 3513–8. doi:10.1073/pnas.0409766102. PMC 548961. PMID 15716360. http://www.pnas.org/content/102/9/3513.full.pdf+html. 
  36. ^ Moncrieff, J. (Jul 2006). "Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse". Acta Psychiatr Scand 114 (1): 3–13. doi:10.1111/j.1600-0447.2006.00787.x. PMID 16774655. http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2006.00787.x/abstract. 
  37. ^ Geodon Withdrawal Retrieved on 3 August 2011

Further reading

External links