[Ziprasidone in Parkinsonian dopamine psychosis]

The dopamine psychosis that appears in Parkinson's disease (PDP) is a complication that is often related with frequent intake of antiparkinsonian agents, especially levodopa and dopamine agonists. Morbidity and the risk of being institutionalised are increased in such patients and therapeutic management is difficult. Its treatment is based on reducing the intake of antiparkinsonian drugs or the use of atypical antipsychotics, due to the fact that they have scarce or no motor effects (at least in theory). In this work, we examine the role that ziprasidone (ZPS) can play in PDP.

We reviewed the studies in which ZPS was used to treat PDP that have appeared in the literature. To date, very few studies have been conducted and only a small number of patients were included in each case. Nevertheless, it seems that, at doses below those used in schizophrenia (20-80 mg/day), ZPS is an effective antipsychotic. In general, the extrapyramidal side effects that do appear are infrequent and mild. Pathological laughter was detected in some patients. The drug was well tolerated and safe.

ZPS seems to be an effective antipsychotic for PDP, with scarce or no extrapyramidal side effects; it is also safe and well tolerated. In view of the scarcity of studies and patients, however, further research is needed (if possible, by means of double-blind randomised trials) to be able to assess the true role of ZPS in PDP.