Ziprasidone is an atypical antipsychotic with a highly specific receptorbinding profile that has been shown to be effective for both positive and negative symptoms of schizophrenia. The agent has been associated with a low frequency of extrapyramidal symptoms and sedative and anticholinergic effects. Four cases of acute ziprasidone overdose were recorded in the database of the department of pharmacovigilance of Pfizer-Spain from January 2003 (when ziprasidone was first marketed in Spain) to October 2004. The doses taken were 780, 1120, 4400, and 4480 mg. In two cases, an excessive ingestion of other drugs such as benzodiazepines and sedative hypnotics was also noted. None of the four cases showed cardiac adverse effects, and the QTc interval was within the normal range in all patients. No relevant neurologic clinical signs were observed, except for mild drowsiness in three cases. Evaluation of these four cases, as well as review of the literature, showed that an overdose of ziprasidone alone, in patients without risk factors that contraindicate its use, is relatively safe.
Background Switching from intravenous (IV) to oral (PO) treatment as soon as patients are clinically stable can reduce the costs associated with IV administration. In this study, we selected levetiracetam, a drug with high bioavailability oral (100%) and a significant cost difference between IV and PO forms. Purpose To estimate avoidable IV levetiracetam use and analyse the potential effect on the hospital drugs budget associated with changing levetiracetam from intravenous to oral treatment. Materials and methods Retrospective observational study performed in patients admitted to the neurosurgical service treated with IV levetiracetam from March 2013 to August 2013 (6 months). We divided levetiracetam-days (LD), into IV levetiracetam days (all doses of levetiracetam were administered IV), and PO levetiracetam days (at least 1 dose administered PO). And we considered IV levetiracetam avoidable when a patient received at least one other oral drug. Data source for costs were the average wholesale prices in 2013. Results A total of 38 patients (24 men, 63%) were included in the study with a mean age of 54.3 (95% CI, 49.1–59.4) years. During study 303 LD were counted, 107 (35%) IV levetiracetam days and 196 (65%) PO levetiracetam days and a median of 2 days IV treatment (interquartile range 1–3). In this period 84 (78.5%) IV levetiracetam days were potentially avoidable, and the cost savings for conversion from IV to PO levetiracetam were calculated to be 2,066 € and the total annual cost savings in the neurosurgery unit 4,132 €. Conclusions Early switching from IV to oral levetiracetam is possible and leads to a substantial reduction in the drugs bill. Explicit physiological criteria should be recorded to serve as a benchmark for successfully switching treatment. No conflict of interest.
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