Psychopharmacology EMIs
Michael Reilly, Bangaru Raju in Extended Matching Items for the MRCPsych Part 1, 2018
Clozapine.Droperidol.Flupenthixol.Olanzapine.Pimozide.Quetiapine.Risperidone.Sulpiride.Trifluoperazine.Ziprasidone.
Generalized Anxiety Disorder
Stephen M. Stahl, Bret A. Moore in Anxiety Disorders: A Guide for Integrating Psychopharmacology and Psychotherapy, 2013
In a very small open-label augmentation pilot trial, aripiprazole (mean dose 13.9 mg/day) produced a response in five out of nine patients, and remission in one. However, three out of the nine developed akathisia within the first week, as well as other side effects, including weight gain (Menza, Dobkin, & Marin, 2007). In an 8-week flexible-dose, open-label augmentation trial, aripiprazole was added to failed treatments of antidepressants or BZDs in 13 patients with GAD, or GAD with panic disorder (Hoge et al., 2008). Both anxiety groups had a significant reduction in their symptoms. An open-label pilot study of ziprasidone (20–80 mg/day) in 13 treatment-resistant GAD patients showed significant reductions from baseline in all measures, with 54& and 38& of subjects meeting criteria for response and remission, respectively. However, no placebo or active control was included (Snyderman, Rynn, & Rickels, 2005). In a follow-up 8-week randomized, double-blind, placebo-controlled, flexible-dose trial, 62 GAD patients received either placebo or ziprasidone, either as an augmentation of continued medications or as monotherapy. There was no difference between the ziprasidone groups and placebo, although the data indicated a better outcome for those patients receiving ziprasidone alone compared with those taking the antipsychotic in conjunction with other medications. Out of 41 ziprasidone patients, 13 dropped out, compared with two of 21 placebo patients (Lohoff, Etemad, Mando, Gallop, & Rickels, 2010).
Metabolic Syndrome: Overview and Relationship with Psychiatric Disorders
Susan L. McElroy, David B. Allison, George A. Bray in Obesity and Mental Disorders, 2006
Other studies have confirmed the differential effects of certain SGAs on lipid profile. In contrast to clozapine, olanzapine, and quetiapine; risperidone, ziprasidone, and ariiprazole are not associated with changes in lipid profile. In a large case-control study involving 18,000 individuals diagnosed with schizophrenia, Koro et al. (92) evaluated the effect of olanzapine, risperidone, conventional antipsychotics, and no antipsychotic exposure on the risk for hyperlipidemia. Olanzapine subjects had a fivefold increase in the odds of developing hyperlidemia, in contrast to risperidone subjects, who had no increase in risk. Results of pooled safety data from aripiprazole trials showed subjects treated with aripiprazole had no significant differences in total cholesterol when compared with placebo (93). In a review of ziprasidone’s effects on serum lipids, ziprasidone was shown to have neutral or favorable effects on patients’ serum lipid profiles in placebo-controlled, active-comparator, and in open label switch studies (91,94–99).
Two cases of priapism associated with Quetiapine
Published in Psychiatry and Clinical Psychopharmacology, 2018
Özge Şahmelikoğlu Onur, Hatice Kızılkale, Hüseyin Yumrukçal, Meltem Gürü
Various drugs have been implicated in priapism. Antipsychotic medications have varying affinities for adrenergic receptors. Although being rare, priapism is a well-known side effect that occurs with first generation antipsychotics; a few cases have also been reported with second generation antipsychotics. Ziprasidone and risperidone have the highest affinity, followed by clozapine and quetiapine for adrenergic receptors [4]. Priapism is attributed to the blockade of alpha-1 adrenergic receptors in corpus cavernosum. This side effect was previously thought to be associated with the use of typical antipsychotics, notably, thioridazine. Atypical antipsychotics, due to their favourable side effect profiles, are being prescribed ever more often and are considered to cause priapism infrequently. However, this side effect has been reported in patients taking ziprasidone, risperidone, clozapine, quetiapine, aripiprazole and olanzapine. The affinity of these drugs to alpha-1 adrenergic receptors vary significantly; affinity of quetiapine, compared to other antipsychotics is intermediate [5].
Safety and tolerability of antipsychotic agents in neurodevelopmental disorders: a systematic review
Published in Expert Opinion on Drug Safety, 2020
Felice Iasevoli, Annarita Barone, Elisabetta Filomena Buonaguro, Licia Vellucci, Andrea de Bartolomeis
Overall, both aripiprazole and risperidone appear safe and tolerable. However, aripiprazole may represent a better tolerable agent in many respects and may be considered the first-line antipsychotic, with risperidone as the second line. Olanzapine and paliperidone should be used when both aripiprazole and risperidone are ineffective or should be avoided for untoward side effects. Data on haloperidol, lurasidone, and ziprasidone are currently inconclusive. Ziprasidone has been studied in small populations but appears a promising agent to prevent detrimental metabolic effects. However, the potential for neurological and cardiological side effects should be bore in mind. Haloperidol use should be discouraged due to the risk of treatment-emergent and treatment-withdrawal motor side effects. Notably, ASD is frequently comorbid with ID. Although available data did not allow to draw firm conclusions, the possibility that adverse events from antipsychotics may vary in ASD patients as a consequence of suffering from comorbid ID or not should be taken into account.
The treatment of acute agitation associated with schizophrenia or bipolar disorder: investigational drugs in early stages of their clinical development, and their clinical context and potential place in therapy
Published in Expert Opinion on Investigational Drugs, 2020
IM ziprasidone at doses of 10 mg and 20 mg have demonstrated efficacy in treating agitation in patients with schizophrenia, as measured by changes in the BARS, when compared to doses of 2 mg IM ziprasidone within 2 h of the first dose [51,52]. This response was seen without excessive sedation and the most common side effects reported in these clinical trials included headache, dizziness, and nausea. One of the safety concerns with ziprasidone is a relatively higher risk of QT interval prolongation among the second-generation antipsychotic class; however, the changes in QT interval appear similar to that observed with haloperidol IM [53]. Ziprasidone is FDA-approved for agitation associated with schizophrenia.
Related Knowledge Centers
- Atypical Antipsychotic
- Dizziness
- Intramuscular Injection
- Psychomotor Agitation
- Somnolence
- Xerostomia
- Schizophrenia
- Bipolar Disorder
- Oral Administration
- Fasciculation