Ziprasidone: uses and side effects of this drug

This psychopharmaceutical is part of the group of drugs known as atypical neuroleptics.

Antipsychotics or neuroleptics are psychotropic drugs used for the treatment of psychotic problems such as schizophrenia, although sometimes they also have other therapeutic indications.

There are a large number of them, with different properties and active ingredients despite having similar mechanisms of action. One of them is ziprasidonewhich we are going to see throughout this article.

What is ziprasidone?

Ziprasidone is an antipsychotic or neuroleptic drug, classified within the atypical or second-generation neuroleptics.. This last clarification is necessary because it allows us to know that it will act not only on dopamine but also on serotonin, so that the levels of the former are altered only to the extent necessary in different brain areas.

In the main problem for which it is used, schizophrenia, there are excessive levels of dopamine in the mesolimbic pathway that end up causing symptoms such as hallucinations, excitability and disorganized and erratic behavior. It is therefore necessary to reduce these levels, which all antipsychotics do.

However, the first or typical antipsychotics generated many side effects or even impaired other types of symptoms present in some cases of schizophrenia, such as alogia or alopecia.such as alogia or poverty of thought, withdrawal or cognitive difficulties. This was due to the fact that the action of classical antipsychotics was not specific to the mesolimbic pathway but occurs throughout the brain.

Thus, areas that were not altered in this sense or that had deficient levels of dopamine such as the mesocortical pathway (this being the cause of negative symptoms such as alogia) were affected. For this reason, further research was carried out and atypical antipsychotics were developed, among them ziprasidone.

Mechanism of action

As an atypical antipsychotic, the mechanism of action of ziprasidone is based on the blockade of dopamine D2 receptors and a large part of serotonin receptors (5HT2A, 5HT1A and 5HT2C), acting as an antagonist of these receptors. Its effect on serotonergic receptors is greater than that of other drugs such as risperidone.. It also has an antagonist effect, although much lesser, on histamine and adrenaline. It also hinders the reuptake of serotonin and norepinephrine in the brain. This means that ziprasidone acts in a way that makes it difficult for these hormones to be used by our neurons.

In the mesolimbic pathway, it causes the excess of dopamine that generates positive symptoms (in the sense that they add elements to the subject's behavior), such as hallucinations and delusions, to be reduced.

Although this drug generates the same effect in the whole brain as in the mesolimbic pathway, the fact that it also acts as an antagonist of serotonin (which is an inhibitor of dopamine secretion), causes dopamine levels in other areas to be maintained or even increased in some points such as the cortex. This results in fewer side effects and that there may be an improvement of the negative symptomatology (poor thinking being one of the most characteristic), which is linked to low levels of dopamine at mesocortical level.

What is this psychotropic drug used for?

There are different disorders in which the use of ziprasidone can generate beneficial effects. Among these different applications and indications we can find the following.

Schizophrenia and other psychotic disorders.

The best known and most frequent indication for ziprasidone is for schizophrenia and other psychotic disorders. schizophrenia and other psychotic-type disorders.It is effective in reducing positive symptomatology and also has an effect on negative symptomatology while generating fewer secondary symptoms than typical antipsychotics.

Bipolar disorder

Another indication for ziprasidone is the treatment of bipolar disorder, specifically manic seizures in bipolar disorder type I. This drug allows the reduction of manic symptoms such as hyperactivity manic symptoms such as hyperactivity, distractibility, feeling of grandiosity, aggression or agitation.aggression or agitation.

Side effects and risks

Like all psychotropic drugs, ziprasidone, although it is an effective medication, can generate a number of unpleasant side effects and potential risks.

As with other antipsychotics, ziprasidone can generate symptoms such as abdominal pain, fever, edema, hypersensitivity to light, hypothermia, hypertension, tachycardia, increased cholesterol, weight gain, nausea and vomiting, some extrapyramidal motor symptoms such as tardive dyskinesia and tremors, pneumonia. Sedation is another common secondary symptom, along with weakness and dizziness..

It can also generate sexual symptoms such as erectile dysfunction such as erectile dysfunction, menstrual disturbances, gynecomastia, galactorrhea, delirium, gait problems, incoordination, anemia, jaundice, arrhythmias and cardiac problems. In some cases it may be necessary to seek immediate medical attention, such as in the presence of convulsions, falls, priapism, loss of consciousness, muscle stiffness or arrhythmias.

Another risk to be taken into account is shared with all antipsychotics: the possibility of developing neuroleptic malignant syndrome, which can lead to the patient's death. Although the risks of this problem are low, it is necessary to control them, control of the doses prescribed and administered to the patient is essential (a process always supervised by the doctors). (a process always supervised by physicians).

Contraindications

Ziprasidone is a potent and very effective drug that cannot be used at all times or in all types of people because it poses a potential health risk. It is contraindicated in people who have had any type of heart problem or disorder.. It is also contraindicated in elderly people suffering from dementia, since it increases the risk of death.

Special care should be taken with the interaction with other medications, as well as the consumption of alcohol. Its use is also not recommended in diabetic patients, with hepatic or renal problems, people with epilepsy or convulsions, breast Cancer or spinal/blood problems. Finally, it is not recommended during pregnancy or lactation. In case of pregnancy, the possibility of changing the type of medication should be discussed with the physician.

Comparison with other antipsychotics

As we have seen, there are numerous antipsychotics, and comparisons have been made between them to test their effectiveness.

In some studies and systematic reviews, it has been found that although highly effective, ziprasidone appears to be slightly less effective than other atypical antipsychotics such as olanzapine or risperidone. However, it has also However, it has also been shown to be less likely to generate side effects..

Specifically, the subjects tested had a lower tendency to gain weight with the medication and less tendency to raise cholesterol. Although in comparison with olanzapine it generated a greater probability of extrapyramidal symptoms and in relation to quetiapine an increase in prolactin (and therefore a greater number of sexual symptoms), in both cases it produced a lower level of these symptoms compared to risperidone. Despite this, the research found that the participants' dropout from the studies generated that these data may be biased.