Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Ziprasidone is an oral and injectable drug that is used for treating psychoses, for example,
schizophrenia. Although the mechanism of action of ziprasidone is not known, like other anti-psychotics, it inhibits communication between nerves of the brain. It does this by blocking receptors on the nerves for several neurotransmitters, the chemicals that nerves use to communicate with each other. It is thought that the beneficial effect of ziprasidone is due to its blocking of
dopamine and serotonin receptors. It also inhibits the re-uptake of serotonin and norepinephrine by nerves in the brain like some anti-depressant drugs. Ziprasidone is associated with little or no weight gain, a feature that distinguishes it from other anti-psychotic drugs. Similarly, ziprasidone is unique among anti-psychotic drugs in that it does not increase cholesterol levels. The FDA approved ziprasidone as a treatment for schizophrenia in February 2001.
PRESCRIPTION: yes
GENERIC AVAILABLE: no
PREPARATIONS: Ziprasidone is available as capsules of 20 mg (blue/white), 40 mg (blue/blue), 60 mg (white/white) and 80 mg (blue/white). The injectable form is available in vials containing 20 mg of lyophilized ziprasidone that must be reconstituted with 1.2 ml of sterile water before injection.
STORAGE: Capsules should be stored at room temperature, between 15 and 30 C (59
and 86 F).
PRESCRIBED FOR: Ziprasidone is
used to treat severe mental disorders like schizophrenia, which are
characterized by distorted thoughts, perceptions, and emotions. Ziprasidone helps manage schizophrenia's "positive symptoms," (visual and auditory hallucinations, and delusions) and may also help in treating the "negative symptoms" of schizophrenia (social withdrawal, apathy, lack of motivation, and an inability to experience pleasure). Ziprasidone also is used to treat acute bipolar mania (manic and mixed episodes) and, in combination with lithium
(Lithobid) or valproate (Depakote, Depakote ER, Depakene, Depacon, Stavzor), for maintenance treatment of bipolar disorder.
DOSING: Ziprasidone usually is taken twice a day. The usual starting dose is 20 mg twice daily. The dose may be increased over time to achieve the desired effect. Ziprasidone should be taken with food (for example, shortly after a meal) since when taken on an empty stomach, much less ziprasidone is absorbed.
DRUG INTERACTIONS: Ziprasidone has a modest effect on the electrical activity of the heart which can be seen on the electrocardiogram (EKG) as a prolongation of the QT-interval. (See discussion below.) Other drugs which also affect the QT interval can add to the effects of ziprasidone and lead to serious
disturbances in the rhythm of the heart. Due to the potential for such additive effects on the QT interval, ziprasidone should not be taken with thioridazine (Mellaril), quinidine (Quinidex), moxifloxacin (Avelox), pimozide (Orap), sotalol (Betapace), dofetilide (Tikosyn), and sparfloxacin (Zagam).
Carbamazepine (Tegretol) increases the body's ability to eliminate ziprasidone and, therefore, may reduce the levels and lessen the effectiveness of ziprasidone. Conversely, ketoconazole (Nizoral) reduces the body's ability to eliminate ziprasidone and may cause increases in levels of ziprasidone and more side effects. Ketoconazole does this by blocking the enzyme that eliminates ziprasidone, cytochrome P450 3A4. Other drugs that also block this enzyme and may increase the levels of ziprasidone include itraconazole (Sporanox), fluconazole (Diflucan), erythromycin, clarithromycin (Biaxin), nefazodone (Serzone), verapamil (Calan, Isoptin, Verelan), and diltiazem (Cardizem, Tiazac, Dilacor).
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Schizophrenia is a disabling brain disorder that may cause hallucinations and delusions and affect a person's ability to communicate and pay attention. Symptoms of psychosis appear in men in their late teens and early 20s and in women in their mid-20s to early 30s. With treatment involving the use of antipsychotic medications and psychosocial treatment, schizophrenia patients can lead rewarding and meaningful lives.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Brief psychotic disorder is a short-term mental illness that features psychotic symptoms. There are three forms of brief psychotic disorder. The first occurs shortly after a major stress, the second has no apparent trauma that triggers the illness, and the third is associated with postpartum onset. Symptoms include hallucinations, delusions, unusual behavior, disorientation, changes in eating and sleeping, and speech that doesn't make sense. Treatment typically involves medication and psychotherapy.
Bipolar disorder, or manic-depressive illness, is a disorder that causes unusual and extreme mood changes. Symptoms of bipolar disorder in children and teens include having trouble concentrating, behaving in risky ways and losing interest in activities they once enjoyed. Treatment for bipolar disorder in children and teenagers incorporates psychotherapy and medications.
Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.
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