Intramuscular Ziprasidone: Moving Beyond the Conventional in the Treatment of Acute Agitation in Schizophrenia

The appropriate management of schizophrenia and schizoaffective disorder requires effective, safeantipsychotic agents for use across a continuum of treatment, from control of acute psychotic episodesto prevention of relapse. Intramuscular (IM) formulations are the method of choice for administeringantipsychotics to schizophrenic patients who require emergency treatment but cannot take oral medication.Atypical antipsychotics are now widely acknowledged as the first-line choice for the managementof patients with schizophrenia. However, use of these agents in acutely agitated psychotic patientshas been limited by the lack of an IM formulation. Ziprasidone is the first, and currently only,atypical antipsychotic to be available in a rapid-acting IM formulation. This review focuses on studiesevaluating the efficacy and tolerability of IM ziprasidone. In agitated psychotic patients, IM ziprasidonereduces agitation as early as 15 minutes after administration, with improvement sustained for ≥ 4hours. In patients with acute psychosis, with or without agitation, IM ziprasidone has been demonstratedto be superior to IM haloperidol in improving overall symptom severity. During the criticalIM-to-oral transition, efficacy and tolerability are maintained with ziprasidone. IM ziprasidone representsan important advance over older, conventional IM agents in the treatment of the acutely ill patientwith schizophrenia.