What is ziprasidone?

Second generation antipsychotics (sometimes referred to as ‘atypical’ antipsychotics) such as ziprasidone are a newer class of antipsychotic medication than first generation ‘typical’ antipsychotics. Second generation antipsychotics are effective for the positive symptoms of schizophrenia. It is sometimes claimed that they are more effective than first generation antipsychotics in treating the negative symptoms of schizophrenia, although the evidence for this is weak. Negative symptoms include a lack of ordinary mental activities such as emotional expression, social engagement, thinking and motivation, whereas positive symptoms include the experiences of perceptual abnormalities (hallucinations) and fixed, false, irrational beliefs (delusions).

Second generation antipsychotics may also cause less extra-pyramidal side effects. These include dyskinesias such as repetitive, involuntary, and purposeless body or facial movements, Parkinsonism (cogwheel muscle rigidity, pill-rolling tremor and reduced or slowed movements), akathisia (motor restlessness, especially in the legs, and resembling agitation) and dystonias such as muscle contractions causing unusual twisting of parts of the body, most often in the neck. These effects are caused by the dopamine receptor antagonist action of these drugs.

What is the evidence for ziprasidone?

High quality evidence suggests ziprasidone improves mental state more than placebo, although moderate quality evidence suggests ziprasidone causes more drowsiness and use of anti-parkinsonian medication.

High quality evidence suggests ziprasidone results in better study retention than haloperidol, and moderate quality evidence suggests ziprasidone may be less likely to cause a movement disorder, but may increase the incidence of gastrointestinal symptoms, than haloperidol.
Moderate to low quality evidence suggests ziprasidone had more participants leave the study early due to inefficacy than amisulpride.

Moderate to high quality evidence suggests olanzapine improves mental state more than ziprasidone. High quality evidence suggests more people leave the study early for any reason, and there are more hospital readmissions with ziprasidone. Moderate quality evidence suggests ziprasidone had less weight gain than olanzapine and high quality evidence suggests more extrapyramidal symptoms with ziprasiodone.

Moderate quality evidence suggests no difference in efficacy between quetiapine and ziprasidone for improving mental state. Moderate quality evidence suggests ziprasidone results in more extrapyramidal symptoms and more prolactin increase, but less weight gain, than quetiapine.

Compared to risperidone, high quality evidence suggests ziprasidone has lower study retention. Moderate quality evidence suggests ziprasidone is less effective for symptoms than risperidone. High quality evidence suggests ziprasidone should produce less weight gain, and less movement disorders than risperidone. Moderate quality evidence suggests less prolactin increase and less extrapyramidal side effects, but greater cholesterol increase, with ziprasidone than risperidone.

October 2020

Last updated at: 5:00 am, 14th October 2020
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