Chemical Restraint in the ED

Ziprasidone (Geodon®) IM... has significant advantages over haloperidol. Ziprasidone exhibits faster onset of action, lack of over-sedation, superior efficacy, reduced EPS, an easier transition to oral ziprasidone, reduced adverse effects and improved medication tolerance. As with olanzapine, most of the positive data stems from psychiatric literature. However, one study conducted in a psychiatric emergency department compared IM ziprasidone to lorazepam / haloperidol combination therapy, and showed a similar side effect profile.

Comparison of IM Midazolam, Olanzapine, Ziprasidone and Haloperidol for Behavioral Control

If rapid sedation with a high chance for success with a single agent is desired, IM midazolam is your drug of choice. Olanzapine should be considered over haloperidol if available. This study does not add to our understanding of sedation of the severely agitated patient.

Delirium in Critical Illness: Haloperidol vs Ziprasidone?

It is vital that the underlying cause and type of delirium be differentiated early as there is limited, if any, use for antipsychotics in patients with hypoactive delirium when compared to placebo. On the other hand, the use of antipsychotics may play a vital role in hyperactive delirium.

Episode 614: Which works better for agitation in the ED – Droperidol, Ziprasidone, or Lorazepam?

Efficacy was 64% for droperidol, 25% and 35% for 10 and 20 mg doses of ziprasidone, and 29% for lorazepam. Despite higher efficacy, the authors found no significant difference between groups in need of additional rescue sedation.

Geodon Went Generic

The positive impact on quality of life will be significant for the person now able to take the generic form of Geodon because the price has dropped so much. People’s health will improve in part because Geodon acts as an appetite suppressant (for me), causing me to actually lose weight as opposed to risperidone (that caused me to gain weight). In addition, Geodon allowed me to reason and think better than risperidone, and now that the cost is so much less, people with terrible or non-existent insurance (and those on public assistance) will have the benefits of this now-generic drug.

Good ol’ Versed

Haldol 5mg, Haldol 10mg, Versed 5mg, Zyprexa 10mg, and Geodon 20mg were all compared, and by far Versed provided the best sedative results. All medications had approximately the same amount of adverse effects.

Haldol vs Geodon

As it's not a conventional antipsychotic like haloperidol (Haldol), it doesn't function solely through dopamine antagonism but also affects serotonin pathways. This varying mode of action means its side-effect profile differs from typical antipsychotics, particularly in that it's less likely to cause extrapyramidal symptoms such as tremors or stiffness - common side effects with drugs like Haldol.

Hidden data show that antipsychotic drugs are less effective than advertised

The two other studies involved Geodon (ziprasidone). One study found Geodon to be no more effective than a placebo. The second found that while Geodon was more effective than a placebo, it was less effective than an older — and much less expensive — drug, Haldol (haloperidol).

Medications to Rapidly Treat Psychotic Agitation

IM ziprasidone appears less effective than IM olanzapine or the IM haloperidol/benzo combination. Ziprasidone was the least effective at reducing scores on the Positive and Negative Syndrome Scale Excited Component in a meta-analysis of randomized controlled trials that examined various pharmacologic treatments for acute agitation. A concern with ziprasidone is that it increases the risk of QTc prolongation in patients with other risks for QTc ­prolongation.

No Reduction in Delirium with the Use of Haloperidol or Ziprasidone in Critically Ill Patients

For patients with acute respiratory failure or shock who develop delirium in the intensive care unit (ICU), the use of haloperidol or ziprasidone (Geodon) does not reduce the duration of delirium. This trial was powered to detect at least a two-day difference in the duration of delirium, so a smaller difference cannot be excluded.

The Art of the ED Takedown

10 to 20 mg IM. Most likely to cause QT prolongation, and has same black box warning as risperidone & olanzapine in dementia related psychosis.

Therapeutics: Agitation in the ED

Ziprasidone is a second generation antipsychotic that is available for PO or IM administration. The typical IM dosing is 10-20 mg. Time to onset of effect is typically 15-20 minutes and ziprasidone reaches peak concentrations in 30-45 minutes. Its duration of effect is at least 4 hours. Of note, ziprasidone also requires reconstitution for IM administration and thus may not rapidly be available for the severely agitated patient. Further, of the second-generation antipsychotics, ziprasidone has the highest risk for QTc prolongation. Ziprasidone is also not recommended in children by some experts due to risk of cardiac effects or potential paradoxical reaction.

Ziprasidone (Geodon) for acute agitation in pediatrics

IM ziprasidone (Geodon) has a relatively quick onset of action with a half-life of 2-5 hours. Although commonly used in adults, there has not been a study looking at an effective dose in pediatrics. Based on the study referenced, the suggested pediatric dose of ziprasidone is 0.2 mg/kg (max 20mg).

Ziprasidone: Did You Know?

Even though there are warnings associated with ziprasidone due to its potential to prolong the QT interval, it still has a place in therapy. Ziprasidone may be most effective in patients who are resistant to standard antipsychotic agents and patients with therapy limiting extrapyramidal symptoms or other adverse effects, such as weight gain and increased cholesterol.