Ziprasidone and haloperidol in the treatment of acute exacerbation of schizophrenia and schizoaffective disorder: comparison of intramuscular and oral formulations in a 6-week, randomized, blinded-assessment study

Abstract

Sequential IM and oral ziprasidone offers important efficacy and tolerability advantages over haloperidol in acute schizophrenia.

Intramuscular aripiprazole for the treatment of acute agitation in patients with schizophrenia or schizoaffective disorder: a double-blind, placebo-controlled comparison with intramuscular haloperidol

“…In an IM olanzapine dose-ranging study, improvements in PEC scores and PEC response rates 2 h after injection did not differ significantly between IM haloperidol and IM olanzapine 5, 7.5, and 10 mg groups (Breier et al 2002). While studies of comparable design have not been performed with IM ziprasidone, an open-label study suggested improved efficacy for flexibly dosed IM ziprasidone over IM haloperidol at the end of up to 3 days of IM treatment in patients with schizophrenia or schizoaffective disorder (Brook et al 2005). Other studies have shown improved efficacy (as assessed by Behavioral Activity Rating Scale scores) during the first 4 h postinjection with IM ziprasidone 10 or 20 mg/injection vs a pseudoplacebo of IM ziprasidone 2 mg/injection in patients with agitation associated with psychiatric disorders (Daniel et al 2001;Lesem et al 2001).…”

Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone

“…Atypical antipsychotics may be associated with prolongation of the QT interval and sudden cardiac death, and appropriate precautions should be taken when administering the drug. 17,33 Although some trials have provided limited evidence for a superior speed of onset 34,35 or degree of response, 32,34,36 other studies have demonstrated similar results between first-generation and second-generation antipsychotics (SGA). 10,37 Moreover, other studies have not consistently demonstrated the superior efficacy of SGA compared to haloperidol alone.…”

Transition from Ziprasidone IM to Oral Formulation in Agitated Patients with Acute Exacerbation of Schizophrenia: An Open Trial

“…Both groups continued to improve after the transition to oral therapy, but patients in the ziprasidone group presented a greater improvement on the CGI-S than haloperidol subjects at the end of the study. The same group published the results of a randomized, fl exibledose, open-label, 6-week multicenter trial, conducted in subjects hospitalized for acute exacerbations of schizophrenia or schizoaff ective disorder, which compared ziprasidone (n = 429) and haloperidol (n = 138) [ 15 ] . Both drugs were administered IM for up to 3 days, with all patients receiving ≥ 2 IM doses.…”

“…The transition from IM to oral ziprasidone has also been evaluated [ 12 , 14, 15 ] . In particular, a 6-week, randomized study by Brook et al, published in 2005, compared sequential IM/oral ziprasidone with haloperidol in acute exacerbations of schizophrenia or schizoaff ective disorders, and demonstrated that sequential IM and oral ziprasidone off er important benefi ts over haloperidol [ 15 ] . Although the results of this landmark study, conducted with a rigorous design, were encouraging, it has been suggested that further clinical experience on the transition from IM to oral ziprasidone is still limited and additional evidence is required, especially on the tolerability [ 3 ] .…”