Thursday, 21 August 2003
This presentation is part of : Thursday Poster Sessions

PD-021 Use of Intramuscular Ziprasidone in Geriatric Patients With Acute Psychosis

Bijan Etemad, Department of Psychiatry, Geriatric Section, Department of Psychiatry, Geriatric Section, University of Pennsylvania, Philadelphia, PA, USA

Objective: Ziprasidone is the first atypical antipsychotic available in both oral and intramuscular (IM) formulation. IM ziprasidone has demonstrated efficacy in controlling agitation, with significant improvement observed as soon as 15 minutes after administration, antipsychotic efficacy superior to that of haloperidol, low incidence of acute dystonia and other extrapyramidal symptoms, and modest effects on QTc interval. Little data are available on the use of IM ziprasidone in geriatric patients. We studied the efficacy and tolerability of IM ziprasidone in geriatric patients with acute psychotic symptoms.
Design: Chart review Methods: Records were reviewed of geriatric patients who were admitted to a psychiatric facility for Axis 1 diagnoses of acute exacerbation of schizophrenia/schizoaffective disorder and who were treated with ziprasidone. Electrocardiograms (ECGs) were administered 2 to 6 hours after IM dosing to monitor cardiac functioning.
Results: Eleven patients were admitted to the University of Pennsylvania Health System with acute psychotic symptoms and behavioral manifestations, including auditory command hallucinations, agitation, and abusive or threatening behavior. Mean age was 76.2 years; 8 were women, 4 were African American, and 7 were Caucasian. Most patients had multiple comorbidities (eg, hypertension, seizure disorder, cardiac abnormalities), and most had received or were still receiving numerous medications, including other antipsychotics. Patients were administered single doses of 20 mg IM ziprasidone. Within 20 to 30 minutes of IM dosing, patients exhibited improvement in behavioral manifestations. Patients were calmed, but not sedated. They were also more receptive to direction by staff, and their social interaction with other patients was improved. Command auditory hallucinations were diminished in severity or ceased. All patients required ³ 2 IM doses PRN; 7 patients daily for 4 days (when they became agitated again or refused oral medication), and 4 patients ³ BID for 6 days. Baseline ECGs were abnormal or borderline in 7 patients. No worsening of cardiac symptoms or ECG changes were observed during IM dosing. No QTc interval > 450 msec was noted. No postural hypotension was observed, except in 1 patient who had to remain in bed for 3 to 4 hours. All patients underwent successful transition to oral ziprasidone.
Conclusion: IM ziprasidone was effective and well tolerated in geriatric patients with schizophrenia who had acute psychotic symptoms and behavioral manifestions.

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