Ziprasidone: uses and side effects of this drug
The antipsychotics or neuroleptics are the psychotropic drugs that are used to treat 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 principles despite having similar mechanisms of action. One of them is ziprasidone , that we will see throughout this article.
- Related article: "Types of antipsychotics (or neuroleptics)"
What is ziprasidone?
Ziprasidone is an antipsychotic or neuroleptic drug, classified as atypical or second-generation neuroleptics . This last clarification is necessary since it allows us to know that it will act not on dopamine but also on serotonin, in such a way that the levels of the former are altered only to the extent necessary in different brain areas.
And is that 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. Therefore it is necessary to reduce these levels, which generates all antipsychotics.
However, the first or typical ones generated many side effects or even harmed other types of symptoms present in some cases of schizophrenia , such as alogia or poverty of thought, withdrawal or cognitive difficulties. This was because the performance of classical antipsychotics was not specific to the mesolimbic pathway, but occurs throughout the brain.
Thus, areas that did not have alterations 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) are affected. For this reason, research was continued and atypical antopsychotics were created, including ziprasidone.
Mechanism of action
As an atypical antipsychotic, the mechanism of action of ziprasidone is based on the blockade of the D2 receptors of dopamine and a large part of the serotonin receptors (5HT2A, 5HT1A and 5HT2C), acting as an antagonist of these. Its effect on serotonergic receptors is greater than that of other drugs such as risperidone . It also has an antagonistic effect, although much less, on histamine and adrenaline. also hinders the reuptake of serotonin and noradrenaline at the brain level. 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 generates that the excess of dopamine that generates positive symptoms (in the sense that they add elements to the behavior of the subject), such as hallucinations and delusions, is 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 inhibitory in the secretion of dopamine), causes that the levels of dopamine in other areas remain the same. or even increase in some points like the cortex. This generates fewer side effects and that there may be an improvement in the negative symptomatology (poverty of thought being one of the most characteristic), which is linked to low levels of dopamine at the mesocortical level.
What is this psychoactive 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 most known and frequent indication for ziprasidone is the corresponding schizophrenia and other psychotic disorders , being effective to reduce the positive symptomatology and also having an effect on the negative at the same time that generating fewer secondary symptoms than the typical antipsychotics.
- You may be interested: "The 6 types of schizophrenia and associated characteristics"
Another indication of ziprasidone is that of the treatment of bipolar disorder, specifically manic crisis in type I bipolar disorder. This medication allows the reduction of Manic symptoms such as hyperactivity, distractibility, sense of grandiosity , aggression or agitation.
- Related article: "Bipolar disorder: 10 features and curiosities you did not know"
Side effects and risks
Like all psychodrugs, ziprasidone, while an effective medication, can generate a series 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 dyskinesia. late and tremors, pneumonia. Sedation in another common secondary symptom, together with weakness and dizziness .
It can also generate sexual symptoms such as erectile dysfunction, alterations in menstruation, gynecomastia, galactorrhea, delusions, gait problems, incoordination, anemia, jaundice, arrhythmias and heart problems. In some cases it may be necessary to go to the medical services immediately, such as in the presence of convulsions, falls, priapism, loss of consciousness, muscle rigidity or arrhythmias.
Another risk to take into account is shared with all antipsychotics: the possibility of suffering from a neuroleptic malignant syndrome that can end with the death of the patient. Although the risks of this problem are low, it is necessary to control them, being essential the control of the doses that are prescribed and supplied to the patient (process always supervised by doctors).
Ziprasidone is a potent and very effective drug that can not be used at any time or in any type of person because it poses a possible risk to health. Is contraindicated in people who have suffered some kind of heart problem or disorder . Also in those elderly who suffer 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 not recommended in diabetic patients, with liver or kidney problems, people with epilepsy or seizures, breast cancer or spinal / blood problems. Finally, neither during pregnancy or lactation. In case of pregnancy you have to consult with the doctor the possibility of changing the type of medication.
Comparison with other antipsychotics
As we have seen, there are numerous antipsychotics, having made comparisons among them to check 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, also it has been shown to have a lower chance of generating side effects .
Specifically, the subjects analyzed had a lower tendency to gain weight with medication and less tendency to raise cholesterol. Although in comparison with olanzapine it generated more likelihood of extrapyramidal symptoms and in relation to quetiapine an increase in prolactin (and therefore a greater number of sexual symptoms), in both cases produced lower level of these symptoms compared to risperidone. Despite this, in the research found that the abandonment of the studies by the participants generated that these data may be biased.
- Komossa, K .; Rummel-Kluge, C .; Hunger, H .; Schwarz, S .; Bhoopathi, P.S .; Kissling, W. & Leucht, S. (2009). Ziprasidone vs other atypical antipsychotics for schizophrenia. Cochrane Database of Systematic Reviews, 4. Art. No .: CD006627. DOI: 10.1002 / 14651858.CD006627.pub2.
- Salazar, M .; Peralta, C .; Pastor, J. (2006). Manual of Psychopharmacology. Madrid, Panamericana Medical Publishing House.