Best clinical practice with ziprasidone: update after one year of experience

This article presents clinical recommendations for using ziprasidone based on information from a year of post-marketing experience. The recommendations are based on the clinical literature, the package insert, presentations at recent meetings, data on file with the manufacturer, and the consensus of a panel of expert psychiatrists. The article provides updates on efficacy and safety data and gives recommendations for dosing and switching strategies. With regard to the QTc issue, there has not been any case of torsades de pointes reported in the more than 150,000 patients who have received ziprasidone since its approval. Ziprasidone is weight neutral and does not appear to cause increases in glucose or lipid levels or in insulin resistance. The panel generally recommends beginning with an initial dose of 80 mg/day (40 mg b.i.d.) rather than the 40 mg/day dose recommended in the package insert. The ability to begin with a therapeutic dose and to titrate up rapidly is an advantage of ziprasidone, especially in treatment settings where admission time is short. In making an elective switch to ziprasidone, the panel recommends a variety of different switching strategies but stresses the importance of trying to maintain a therapeutic dose of one antipsychotic at all times.