Ziprasidone vs Other Atypical Antipsychotics for Schizophrenia

Peter Yellowlees, MBBS, MD


March 09, 2010

This feature requires the newest version of Flash. You can download it here.

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees. Atypical antipsychotic agents are now widely used as the first choice drug treatment for schizophrenia. As a group, though, they have varying levels of efficacy and tolerability and we need to examine them more closely to improve our ability to individualize care for patients. Seven investigators[1]from the Technical University in Munich, Germany, have undertaken a systematic review to compare the efficacy and tolerability of ziprasidone with amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and zotepine in people with schizophrenia or schizophrenia-like psychoses. They searched the Cochrane Schizophrenia Group Specialized Register and the references of all identified studies for further trial citations and contacted pharmaceutical companies and authors of trials for additional information. They included all randomized, at least single-blind, controlled trials comparing oral ziprasidone with 1 or more of the other drugs. The review included 9 randomized controlled trials with 3361 participants. The overall rate of premature study discontinuation was very high (59.1%), which they noted limits the validity of the findings. The authors concluded that ziprasidone may be a slightly less efficacious antipsychotic drug than amisulpride, olanzapine, and risperidone. Ziprasidone produced less weight gain than olanzapine or risperidone and was associated with less cholesterol increase than olanzapine, quetiapine, and risperidone. Conversely, ziprasidone produced slightly more extrapyramidal side effects than olanzapine and more prolactin increase than quetiapine. They concluded that ziprasidone's main advantage is the low propensity to induce weight gain and associated adverse effects. It is clear that more comparative studies of the atypical antipsychotic agents are needed. This article is selected from Medscape Best Evidence. I'm Dr. Peter Yellowlees.