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Intramuscular Ziprasidone Dosing for Acute Agitation in the Pediatric Emergency Department: An Observational Study
Tammy Nguyen1,2, Jillian Stanton1, Robin Foster2
11 Department of Pharmacy, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
Insights
Pediatric emergency department patients needing only one dose of intramuscular ziprasidone received a higher initial dose (0.19 mg/kg) than those needing additional medication. An initial dose of 0.2 mg/kg may be appropriate for acute agitation in children.
Area of Science:
- Emergency Medicine
- Pediatric Pharmacology
- Psychopharmacology
Background:
- Intramuscular ziprasidone is frequently used for acute agitation in emergency settings.
- Limited data exist regarding optimal pediatric dosing in the emergency department (ED).
Purpose of the Study:
- To compare the initial milligram per kilogram (mg/kg) dosing of intramuscular ziprasidone between pediatric patients who responded to treatment and those who did not.
- To inform pediatric dosing guidelines for intramuscular ziprasidone in the ED.
Main Methods:
- Retrospective, observational study of 5- to 18-year-old patients treated with intramuscular ziprasidone in a pediatric ED (2007-2015).
- Patients were classified as responders if no additional rescue medication for acute agitation was needed within 30 minutes of the initial dose.
- Demographic and clinical data were extracted from medical records.
Main Results:
- Forty children received 50 doses of intramuscular ziprasidone.
- Sixty-eight percent (27/40) of patients responded to the initial dose.
- Responders received a mean initial dose of 0.19 ± 0.1 mg/kg, while non-responders received 0.13 ± 0.06 mg/kg (P = .03).
Conclusions:
- A statistically significant difference in initial dosing exists between pediatric patients who respond to a single dose of intramuscular ziprasidone and those requiring additional medication.
- An initial intramuscular ziprasidone dose of 0.2 mg/kg may be considered for managing acute agitation in pediatric ED patients.
Background:
Intramuscular (IM) ziprasidone is often used to manage acute agitation. Limited data exist on the pediatric dosing of ziprasidone in the emergency department (ED).
Objective:
To characterize the mg/kg dosing differences between pediatric ED patients who respond to an initial dose of ziprasidone versus patients who do not.
Methods:
This was a retrospective, observational study of 5- to 18-year-old patients who were treated with IM ziprasidone in the pediatric ED from 2007 to 2015. Medical records were reviewed to determine demographic and clinical information. Patients were deemed responders to ziprasidone if they required no additional rescue medication for acute agitation within 30 minutes of the initial dose.
Results:
Forty children received 50 doses of IM ziprasidone. Twenty-seven (68%) patients responded to the initial ziprasidone dose, requiring no further medication intervention for their acute agitation. Responders were given a mean initial dose of 0.19 ± 0.1 mg/kg, while nonresponders were given an initial mean dose of 0.13 ± 0.06 mg/kg ( P = .03).
Conclusion:
A significant dose difference exists between patients who required only one initial dose of ziprasidone compared to those who required additional medication. As a result, an initial dose of 0.2 mg/kg of IM ziprasidone may be considered when managing acutely agitated pediatric patients in the ED.
