Ziprasidone-Induced Acute Dystonic Reactions in Patients With Bipolar Disorder

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Sir: We have recently observed 2 cases of acute dystonic reactions in ziprasidone-treated patients with bipolar disorder. Although characterized by relatively high dopamine-2 (D2) binding, ziprasidone has been associated with a low rate of extrapyramidal symptoms and dystonia.^1,2 Of 4 early clinical trials with ziprasidone,^3-6 only 1 trial, in patients with schizophrenia and schizoaffective disorder, has reported any dystonia.³