Side Effects of ziprasidone: A Synthesis of Findings from 24 Studies

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Original Abstract of the Article

Main Research Findings

Ziprasidone is a second-generation antipsychotic used to treat mental illnesses like schizophrenia and bipolar disorder. Studies have shown that ziprasidone has a relatively lower risk of side effects like weight gain and metabolic problems compared to other antipsychotics. However, there are potential side effects associated with ziprasidone, including QTc prolongation, extrapyramidal symptoms, increased blood sugar levels, lipid abnormalities, and elevated prolactin levels. 8

Research suggests that ziprasidone might have a lower incidence of side effects compared to other antipsychotics. Nevertheless, it's important to note that ziprasidone, like other antipsychotics, can still cause side effects such as weight gain and metabolic issues. 5

Reasons for Side Effects

Ziprasidone works by affecting both dopamine and serotonin receptors, helping to manage symptoms of mental illness. However, its action on these neurotransmitter receptors can lead to side effects. For example, weight gain is thought to be linked to the blocking of dopamine receptors, while metabolic problems might be associated with serotonin receptor blocking.

Common Side Effects

Weight Gain

Ziprasidone has been reported to cause less weight gain than other antipsychotics. 5 However, a study found that approximately 23% of patients taking ziprasidone experienced a weight increase of 7% or more. 5

Metabolic Abnormalities

Ziprasidone can potentially cause metabolic abnormalities such as lipid abnormalities and increased blood sugar levels. 5 A study observed that many patients taking ziprasidone experienced elevated total cholesterol and LDL cholesterol levels. 5

Extrapyramidal Symptoms (EPS)

Ziprasidone has been reported to have a lower incidence of extrapyramidal symptoms compared to other antipsychotics. 5 However, around 10% of patients taking ziprasidone experienced EPS like akathisia. 6

QTc Prolongation

Ziprasidone can potentially affect the electrical activity of the heart and cause QTc prolongation. 18 QTc prolongation can increase the risk of ventricular arrhythmias and sudden death.

Elevated Prolactin Levels

Ziprasidone can elevate prolactin levels. 5 Prolactin is a hormone linked to milk production and menstruation. Elevated prolactin levels can cause milk production in women, menstrual irregularities, decreased libido, and breast enlargement in men.

Other Side Effects

Ziprasidone can cause the following side effects: 2

  • Dry mouth
  • Constipation
  • Dizziness
  • Drowsiness
  • Fatigue
  • Headache
  • Indigestion
  • Gingival pain
  • Allergic reactions

Side Effects Management

Managing Weight Gain

Maintaining a healthy diet and engaging in regular exercise are crucial for preventing weight gain. 5 You can also discuss medication options with your doctor to help manage weight gain.

Managing Metabolic Abnormalities

A healthy diet and regular exercise are essential for preventing metabolic problems. 5 It's also advisable to consult your doctor to explore medication options for managing lipid abnormalities and high blood sugar levels.

Managing Extrapyramidal Symptoms

If you experience EPS, it's important to talk to your doctor and consider medication options to alleviate the symptoms. 6

Managing QTc Prolongation

Patients at higher risk of QTc prolongation should undergo an electrocardiogram (ECG) before starting ziprasidone to ensure their heart's electrical activity is normal. 18 If you experience any heart problems while taking ziprasidone, consult your doctor immediately.

Managing Elevated Prolactin Levels

If your prolactin levels are elevated, consult your doctor and explore medication options to manage the symptoms.

Comparison Across Studies

Research Similarities

Multiple studies have shown that ziprasidone, compared to other antipsychotics, causes relatively fewer side effects like weight gain and metabolic problems.

Research Differences

The incidence of side effects associated with ziprasidone varies across studies. This variation could be influenced by factors such as the characteristics of study participants, dosages of ziprasidone, and other contributing variables.

Real-World Application Considerations

It is essential to take ziprasidone precisely as directed by your doctor. Ziprasidone can interact with other medications, so inform your doctor if you are taking any other drugs. If you experience mood changes, dizziness, drowsiness, or any other symptoms while on ziprasidone, exercise caution, such as avoiding driving or operating machinery.

Current Research Limitations

Research on the side effects of ziprasidone remains incomplete. Specifically, long-term side effect studies are lacking. Therefore, there are still many unanswered questions about the long-term safety of ziprasidone.

Future Research Directions

Research on the long-term safety of ziprasidone and methods to mitigate side effects is needed. Additional studies focusing on identifying patients at higher risk of ziprasidone side effects are also crucial.

Conclusion

Ziprasidone is an effective medication for treating mental illnesses like schizophrenia and bipolar disorder, but it can cause side effects such as weight gain, metabolic problems, QTc prolongation, extrapyramidal symptoms, and elevated prolactin levels. It is essential to take ziprasidone precisely as instructed by your doctor. If you are concerned about side effects, discuss them with your healthcare provider.

Literature analysis of 24 papers
Positive Content
11
Neutral Content
5
Negative Content
8
Article Type
5
2
2
2
23
1.

Pharmacogenetics of adverse events in schizophrenia treatment: comparison study of ziprasidone, olanzapine and perazine.

Author: TyburaPiotr, Trześniowska-DrukałaBeata, BienkowskiPrzemyslaw, BeszlejAleksander, FrydeckaDorota, MierzejewskiPawel, SamochowiecAgnieszka, GrzywaczAnna, SamochowiecJerzy

Schizophrenia treatment
Extrapyramidal symptoms
Weight gain

The study found no association between genetic polymorphisms and changes in body weight or extrapyramidal symptoms (EPS) related to antipsychotic treatment in paranoid schizophrenia patients.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

2.

Gingival pain: an unusual side effect of ziprasidone.

Author: RaghunathAshwati

Gingival pain

This case report describes a patient with schizophrenia who developed severe gingival pain after his ziprasidone dosage was increased. The pain subsided after taking benztropine and the patient's ziprasidone dosage was decreased.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

4.

Current Management of Tics and Tourette Syndrome: Behavioral, Pharmacologic, and Surgical Treatments.

Author: BillnitzerAndrew, JankovicJoseph

Tic control
Metabolic syndrome
Tardive dyskinesia

Tourette syndrome, a neurobehavioral disorder characterized by tics, often requires a multidisciplinary approach to treatment. This review provides an overview of treatment options, including behavioral therapy, pharmacological therapies, and experimental therapies such as deep brain stimulation.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

5.

Comparison of metabolic effects of aripiprazole, quetiapine and ziprasidone after 12 weeks of treatment in first treated episode of psychosis.

Author: Pérez-IglesiasRocio, Ortiz-Garcia de la FozVictor, Martínez GarcíaObdulia, AmadoJose Antonio, Garcia-UnzuetaM Teresa, Ayesa-ArriolaRosa, Suarez-PinillaPaula, Tabares-SeisdedosRafael, Crespo-FacorroBenedicto

Lipid abnormalities
Prolactin increase
Weight gain

This study compared the metabolic side effects of three antipsychotic medications – aripiprazole, ziprasidone, and quetiapine – in patients with first-episode psychosis. The findings suggest that ziprasidone may have a lower risk of weight gain and lipid abnormalities compared to the other two medications.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

6.

Persistent akathisia masquerading as agitated depression after use of ziprasidone in the treatment of bipolar depression.

Author: PendersThomas M, AgarwalSalina, RohaidyRachel

Bipolar depression treatment
Akathisia

This case report describes the development of severe akathisia, a side effect characterized by restlessness and agitation, in a patient being treated with ziprasidone for bipolar depression.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.

Language : English

7.

Clozapine, ziprasidone, and sertindole-induced morphological changes in the rat heart and their relationship to antioxidant enzymes function.

Author: Nikolić-KokićAleksandra, TatalovićNikola, NestorovJelena, MijovićMilica, MijuskovićAna, MilerMarko, Oreščanin-DušićZorana, NikolićMilan, MiloševićVerica, BlagojevićDuško, SpasićMihajlo, MiljevićČedo

Cardiomyocyte degeneration
Lymphocytic infiltration
Myocarditis
Oxidative stress
Pericardial histopathological alterations

This study investigated the influence of three atypical antipsychotics (clozapine, ziprasidone, and sertindole) on rat heart morphology and redox imbalance. All drugs induced toxic myocarditis, with clozapine showing the most severe effects. Clozapine increased SOD1 activity, while ziprasidone reduced GR activity. These findings suggest that clozapine and ziprasidone may induce heart damage by altering antioxidant capacity.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

9.

[Effects of ziprasidone and olanzapine on glucose and lipid metabolism in first-episode schizophrenia].

Author: ShaoPing, OuJianjun, WuRenrong, FangMaosheng, ChenHonghui, XuYi, ZhaoJingping

Ziprasidone
Glucose and lipid metabolism
Olanzapine
Weight gain

A study of 245 patients with first-episode schizophrenia found that ziprasidone had less of an effect on glucose and lipid metabolism than olanzapine in short-term treatment. Patients treated with olanzapine had higher weight gain and significant increases in FBS, fasting insulin, HDL, TC, TG, LDL, and IRI levels, which is associated with an increased risk of complications.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : Chinese

10.

Parenteral Sustained Release Lipid Phase-Transition System of Ziprasidone: Fabrication and Evaluation for Schizophrenia Therapy.

Author: KhanUrooj A, ParveenUzma, HasanNazeer, AhmedMohammad Zubair, SaadSuma, AhmadFarhan J, JainGaurav K

Sustained release

This article discusses the development of a parenteral ziprasidone-loaded sustained release phospholipid based phase-transition system (ZP-LPS) to improve the bioavailability and therapeutic efficacy of ziprasidone, an atypical antipsychotic agent.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

11.

Two models for weight gain and hyperphagia as side effects of atypical antipsychotics in male rats: validation with olanzapine and ziprasidone.

Author: ShoboMiwako, YamadaHiroshi, MiharaTakuma, KondoYuji, IrieMegumi, HaradaKatsuya, NiKeni, MatsuokaNobuya, KayamaYukihiko

Obesity
Weight gain

Chronic olanzapine treatment induced weight gain and hyperphagia in male rats.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

12.

Quality of life in patients with schizophrenia: the impact of socio-economic factors and adverse effects of atypical antipsychotics drugs.

Author: de AraújoAurigena Antunes, de Araújo DantasDiego, do NascimentoGemma Galgani, RibeiroSusana Barbosa, ChavesKatarina Melo, de Lima SilvaVanessa, de AraújoRaimundo Fernandes, de SouzaDyego Leandro Bezerra, de MedeirosCaroline Addison Carvalho Xavier

Improved schizophrenia
Anxiety/depression
Mobility issues
Pain/discomfort
Side effects
Usual activities problems

This study found that atypical antipsychotic drugs used to treat schizophrenia can have significant side effects, including impacting quality of life, particularly for those with low socioeconomic status.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

13.

Characteristics of adverse reactions among antipsychotic drugs using the Korean Adverse Event Reporting System database from 2010 to 2019.

Author: OhSanghoon, ByeonSun-Ju, ChungSoo Jie

Antipsychotic treatment
Adverse drug reactions

This study aimed to investigate the adverse effects of antipsychotics in Asia through a large-scale epidemiological study using spontaneous reporting system databases.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

14.

Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis.

Author: HuhnMaximilian, NikolakopoulouAdriani, Schneider-ThomaJohannes, KrauseMarc, SamaraMyrto, PeterNatalie, ArndtThomas, BäckersLio, RothePhilipp, CiprianiAndrea, DavisJohn, SalantiGeorgia, LeuchtStefan

Antipsychotic efficacy

This study compared and ranked antipsychotic drugs for schizophrenia based on information from randomized controlled trials.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

15.

The Influence of a Xanthine-Catechin Chemical Matrix on in vitro Macrophage-Activation Triggered by Antipsychotic Ziprasidone.

Author: DuarteThiago, BarbisanFernanda, da CunhaBeatriz Sadigurski Nunes, AzzolinVerônica Farina, TurraBárbara Osmarin, DuarteMarta Maria Medeiros Frescura, da Cruz JungIvo Emilio, RibeiroEuler Esteves, do Prado-LimaPedro Antônio, da CruzIvana Beatrice Mânica

ZIP side effects reduction

Ziprasidone (ZIP) is an antipsychotic that can cause inflammation. Some foods contain molecules that may help to reduce inflammation caused by ZIP.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

16.

Ziprasidone, a second-generation antipsychotic drug, triggers a macrophage inflammatory response in vitro.

Author: DuarteThiago, BarbisanFernanda, do Prado-LimaPedro Antônio Schmidt, AzzolinVerônica Farina, da Cruz JungIvo Emílio, DuarteMarta Maria Medeiros Frescura, TeixeiraCibele Ferreira, MastellaMoises Henrique, da CruzIvana Beatrice Mânica

Allergic reactions
Peripheral inflammation

Ziprasidone, an antipsychotic drug, can trigger an inflammatory response in macrophages. While it has fewer metabolic side effects compared to other antipsychotics, it can cause allergic reactions in some patients. This study found that ziprasidone increases the production of inflammatory molecules and cytokines in macrophages, suggesting a potential mechanism for its allergic effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

17.

Neuromotor Adverse Effects in 342 Youth During 12 Weeks of Naturalistic Treatment With 5 Second-Generation Antipsychotics.

Author: CarbonMaren, KapoorSandeep, SheridanEva, Al-JadiriAseel, AzzoSally, SarkariaTania, KaneJohn M, SaitoEma, CorrellChristoph U

Low EPS rates
Dyskinesia
Parkinsonism

In youth, the rates of extrapyramidal side effects (EPS) associated with second-generation antipsychotics (SGAs) were similar to those reported in adults. EPS were lower for quetiapine and olanzapine.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Observational StudyResearch that observes and collects data on participants' behavior and outcomes in their natural state, without intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

18.

ATAD3B and SKIL polymorphisms associated with antipsychotic-induced QTc interval change in patients with schizophrenia: a genome-wide association study.

Author: LuZhe, ZhangYuyanan, YanHao, SuYi, GuoLiangkun, LiaoYundan, LuTianlan, YuHao, WangLifang, LiJun, LiWenqiang, YangYongfeng, XiaoXiao, LvLuxian, TanYunlong, ZhangDai, YueWeihua

Antipsychotic choice guidance
QTc interval prolongation

A genome-wide association study (GWAS) identified two novel loci associated with antipsychotic-induced QTc interval change in patients with schizophrenia. Combining polygenic risk score (PRS) with clinical data could predict QTc interval prolongation in patients with schizophrenia, particularly those experiencing their first episode.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

19.

A randomized, double-blind, placebo-controlled study of ziprasidone monotherapy in bipolar disorder with co-occurring lifetime panic or generalized anxiety disorder.

Author: SuppesTrisha, McElroySusan L, SheehanDavid V, HidalgoRosario B, CosgroveVictoria E, GwizdowskiIola S, FeldmanNatalie S

Ziprasidone has negative side effects
Ziprasidone ineffective for anxiety

This study found that ziprasidone monotherapy was not associated with clinically significant improvement in anxiety symptoms or function for patients with bipolar disorder, lifetime panic disorder or GAD, and concurrent moderately severe anxiety symptoms, and it was associated with a more negative side-effect profile relative to placebo.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

20.

Electroconvulsive therapy for treatment-resistant schizophrenia.

Author: SinclairDiarmid Jm, ZhaoSai, QiFang, NyakyomaKazare, KwongJoey Sw, AdamsClive E

Treatment for schizophrenia
Memory loss

Electroconvulsive therapy (ECT) is a controversial treatment for schizophrenia, with concerns about long-term side effects like memory loss. This review examines the clinical efficacy and safety of ECT for individuals with schizophrenia who are not responding to their treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

21.

WEIGHT GAIN AND ANTIPSYCHOTICS. DATA FROM EUFEST STUDY.

Author: MateiV P, MihailescuA, ParaschivG, Al-BatainehR, PurnichiT

Weight gain

Weight gain is a common side effect of antipsychotic treatment for schizophrenia. In this study, weight gain was observed in all antipsychotic groups, with the greatest increase occurring in the first three months of treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

22.

Among the severely mentally ill, who responds to ziprasidone?

Author: BarkNigel, LawsonNicholas, TrigoboffEileen, VaradiRodica, GraceJeffery, OlympiaJosie, SindhuNighat, WatsonTom, El-DefrawiMohamed, RoyPunyabrata

Schizophrenia treatment
Ziprasidone

This study investigated the effectiveness of ziprasidone in state hospital patients with severe mental illness who required a change in antipsychotic medication. While ziprasidone was effective in older outpatients, it showed little improvement in younger inpatients.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

24.

Early nonresponse determined by the clinical global impressions scale predicts poorer outcomes in youth with schizophrenia spectrum disorders naturalistically treated with second-generation antipsychotics.

Author: Stentebjerg-OlesenMarie, JeppesenPia, PagsbergAnne K, Fink-JensenAnders, KapoorSandeep, ChekuriRaja, CarbonMaren, Al-JadiriAseel, KishimotoTaishiro, KaneJohn M, CorrellChristoph U

Predict treatment response

This study assesses whether early improvement on the Clinical Global Impressions-Improvement (CGI-I) scale predicts ultimate response to antipsychotic treatment in psychiatrically ill youth. The study aims to identify a way to predict treatment response early on, potentially reducing ineffective treatment continuation.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

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