Portal de Periódicos da CAPES

Ziprasidone Overdose

2000; American Psychiatric Association; Volume: 157; Issue: 5 Linguagem: Português

10.1176/appi.ajp.157.5.835

1535-7228

Simon C. Burton, Karen Heslop, Kylie Harrison, M.R. Barnes,

Attention Deficit Hyperactivity Disorder

Back to table of contents Previous article Next article Letter to the EditorFull AccessZiprasidone OverdoseSIMON BURTON, M.B., CH.B., B.MED.SCI., F.R.A.N.Z.C.P., KAREN HESLOP, B.N., GRAD.DIP., M.ED., KERRY HARRISON, B.SCI., R.N., and MARK BARNES, M.B., CH.B., F.R.A.N.Z.C.P., SIMON BURTON, M.B., CH.B., B.MED.SCI., F.R.A.N.Z.C.P., KAREN HESLOP, B.N., GRAD.DIP., M.ED., KERRY HARRISON, B.SCI., R.N., and MARK BARNES, M.B., CH.B., F.R.A.N.Z.C.P., Queensland, AustraliaPublished Online:1 May 2000AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Ziprasidone is a combined 5-HT (serotonin) and dopamine receptor antagonist (1, p. 101) that has been administered in controlled trials to over 3,000 patients with schizophrenia and schizoaffective disorder (2). Ziprasidone is a unique molecule with a neuropharmacological profile distinct from those of both the standard and newer antipsychotics (2). It possesses a high in vitro 5-HT2A/dopamine D2 receptor affinity ratio (1) and is also an agonist at the 5-HT1A and 5-HT1D receptors. It is a 5-HT and noradrenaline reuptake inhibitor, which suggests that it may have use in treating psychotic depression (2). Given the patient population for which antipsychotic medications are intended, the potential for overdose is high. We report the details of a patient overdose. The case has been reported to the U.S. Food and Drug Administration.Mr. A, a 50-year-old man with a well-established diagnosis of chronic paranoid schizophrenia, was admitted to a hospital's emergency department 4.5 hours after an overdose of 3120 mg of ziprasidone (52 60-mg tablets of ziprasidone and 26 placebo tablets). He said he had not taken any other prescribed or illicit drugs or drunk any alcohol; he had not vomited. He was conscious and cooperative.Mr. A was connected to a cardiac monitor and a pulse oximeter. His Glasgow Coma Scale (3) score was 15. His blood pressure at admission was 200/95 mm Hg; it decreased to 160/80 mm Hg within 1.5 hours; then it remained in the normal range. His axillary temperature was 36.5°C. His pulse ranged from 70 to 90 bpm. His Sao2 was between 96% and 99% with room air. He was a little drowsy, and his speech was slightly slurred.An ECG performed on Mr. A showed some minimal QT prolongation (QT/QTc 430/490 msec) and nonspecific flattening of the T wave. He had no arrhythmias. Four ECGs per hour were performed. Blood was taken for a CBC, to check liver function, and to test electrolyte, magnesium, and acetaminophen levels. The results were within normal limits. An intravenous infusion with normal saline solution was begun at a rate of 8 liters per hour. An intravenous infusion of 10 mg of metoclopramide was given, along with 50 mg of oral charcoal and 150 ml of sorbitol.Mr. A's first two postoverdose ECGs showed minimal QT prolongation and nonspecific change in the morphology of the T wave compared to his pretreatment ECG. This change was maximal at 6 hours postoverdose, which would correlate with the peak plasma level of ziprasidone (4). His ECG readings then returned to normal.This is the first reported overdose of ziprasidone, to our knowledge. The quantity of the medication ingested appears to be accurate and is substantial, representing a 26 days' supply of ziprasidone at the upper end of the recommended dose range. Charcoal and sorbitol were administered 5 hours postoverdose. A substantial quantity of the drug would have been absorbed because peak plasma levels occur 4–6 hours after oral administration (4).Throughout the patient's 13-hour stay in the emergency department, his central nervous system functioned normally, with no extrapyramidal side effects. He was oriented and showed no evidence of delirium. No arrhythmias were noted during his cardiac monitoring or on his ECGs. There was only minimal and transient QT change and no hemodynamic abnormality. These observations suggest relative cardiac safety.It is premature to draw any general conclusions from this single incident of an overdose of ziprasidone, but our findings suggest relative safety. Patients should have general supportive treatment, as described here, and ECG monitoring.References1. Seeger TF, Seymour PA, Schmidt AW, Zorn SH, Schulz DW, Lebel LA, McLean S, Guanowsky V, Howard HR, Lowe JA, Heym J: Ziprasidone (CP-88, 059): a new antipsychotic with combined dopamine and serotonin receptor antagonist activity. J Pharmacol Exp Ther 1995; 275:101–113Medline, Google Scholar2. Borison RL: Recent advances in the pharamacotherapy of schizophrenia. Harv Rev Psychiatry 1997; 4:255–271Crossref, Medline, Google Scholar3. Teasdale G, Jennett B: Assessment of coma and impaired consciousness: a practical scale. Lancet 1974; 2:81–84Crossref, Medline, Google Scholar4. Prakash C, Kamel A, Gummerus J, Wilner K: Metabolism and excretion of a new antipsychotic drug, ziprasidone, in humans. Drug Metab Dispos 1997: 25:863–872Google Scholar FiguresReferencesCited byDetailsCited byIn vitro degradation of ziprasidone in human whole blood7 November 2022 | Drug Testing and Analysis, Vol. 15, No. 2Neuroleptic drugsAtypical antipsychotics: trends in analysis and sample preparation of various biological samplesBioanalysis, Vol. 4, No. 8Clinical Toxicology, Vol. 49, No. 7Drug-induced block of cardiac HERG potassium channels and development of torsade de pointes arrhythmias: the case of antipsychotics18 February 2010 | Journal of Pharmacy and Pharmacology, Vol. 57, No. 2Torsade de Pointes After Ziprasidone Overdose With CoingestantsJournal of Clinical Psychopharmacology, Vol. 30, No. 1The American Journal of Emergency Medicine, Vol. 27, No. 5Pediatric Emergency Care, Vol. 25, No. 4Pediatric Emergency Care, Vol. 25, No. 7American Journal of Health-System Pharmacy, Vol. 65, No. 11Emergency Medicine Clinics of North America, Vol. 25, No. 2Clinical Toxicology, Vol. 45, No. 7Clinical Toxicology, Vol. 45, No. 8Der Nervenarzt, Vol. 77, No. 3Neuroleptic drugsPsychosomatics, Vol. 47, No. 3The American Journal of Emergency Medicine, Vol. 23, No. 4General Hospital Psychiatry, Vol. 27, No. 3CNS Spectrums, Vol. 10, No. S11Current Opinion in Pediatrics, Vol. 17, No. 2Acta Psychiatrica Scandinavica, Vol. 112, No. 1Pharmacotherapy, Vol. 25, No. 11QTc Prolongation in Multiple Drug OverdoseJournal of Clinical Psychopharmacology, Vol. 24, No. 3The Journal of Emergency Medicine, Vol. 27, No. 4Extrapyramidal Symptoms in Children on Atypical Antipsychotic DrugsJournal of Clinical Psychopharmacology, Vol. 23, No. 6Lithium-Associated Psoriasis and Omega-3 Fatty AcidsGRAD W. AKKERHUIS, M.Sc., and WILLEM A. NOLEN, M.D., Ph.D., 1 July 2003 | American Journal of Psychiatry, Vol. 160, No. 7Side Effects of ZiprasidoneJEFFREY TEICH, M.D., 1 July 2003 | American Journal of Psychiatry, Vol. 160, No. 7Antipsychotics and QT prolongation17 January 2003 | Acta Psychiatrica Scandinavica, Vol. 107, No. 2Journal of Toxicology: Clinical Toxicology, Vol. 41, No. 1Journal of Toxicology: Clinical Toxicology, Vol. 41, No. 2CNS Drugs, Vol. 17, No. 5Ziprasidone in the Management of SchizophreniaCNS Drugs, Vol. 17, No. 6Ziprasidone Mesylate for Injection20 July 2017 | Hospital Pharmacy, Vol. 37, No. 12Quetiapine for Olanzapine-Induced GalactorrheaSTEVEN J. KINGSBURY, M.D., PH.D., CATHERINE CASTELO, M.D., and OSAMA ABULSEOUD, M.D., 1 June 2002 | American Journal of Psychiatry, Vol. 159, No. 6Overdose of ZiprasidoneMATT HOUSE, D.O., 1 June 2002 | American Journal of Psychiatry, Vol. 159, No. 6Ziprasidone: The Fifth Atypical Antipsychotic28 June 2016 | Annals of Pharmacotherapy, Vol. 36, No. 5Clinical Therapeutics, Vol. 24, No. 1Antipsychotic drugsJournal of Psychiatric Practice, Vol. 8, No. 2Ziprasidone20 July 2017 | Hospital Pharmacy, Vol. 36, No. 6Reactions Weekly, Vol. &NA;, No. 817 Volume 157Issue 5 May 2000Pages 835-835 Metrics History Published online 1 May 2000 Published in print 1 May 2000