Antipsychotics or neuroleptics are psychotropic drugs used to treat psychotic problems such as schizophrenia, although sometimes they also have other therapeutic indications.
There are a large number of them, with different properties and active ingredients despite having similar mechanisms of action. One of them is ziprasidone which we are going to see throughout this article.
Ziprasidone is an antipsychotic or neuroleptic drug, classified within atypical or second generation neuroleptics This last clarification is necessary since it allows us to know that it will act not on dopamine but also on serotonin, in such a way that the levels of the former are altered only to the necessary extent in different brain areas.
And in the main problem for which it is used, schizophrenia, there are excessive levels of dopamine in the mesolimbic pathway that end up causing symptoms such as hallucinations, excitability and disorganized and erratic behavior. Therefore, it is necessary to reduce these levels, something that all antipsychotics generate.
However, the first or typical ones generated many side effects or even harmed other types of symptoms present in some cases of schizophrenia, such as alogia or poverty of thought, withdrawal or cognitive difficulties. This was because the action of classical antipsychotics was not specific to the mesolimbic pathway but rather occurs throughout the brain.
Thus, areas that did not have alterations in this sense or that had deficient levels of dopamine such as the mesocortical pathway (this being the cause of negative symptoms such as alogia) are affected. For this reason, research continued and atypical antopsychotics were created, including ziprasidone.
As an atypical antipsychotic, the mechanism of action of ziprasidone is based on the blockade of dopamine D2 receptors and a large part of the serotonin receptors (5HT2A, 5HT1A and 5HT2C), acting as an antagonist of these. Its effect on serotonergic receptors is greater than that of other drugs such as risperidone It also has an antagonistic effect, although much smaller, on histamine and adrenaline. It also hinders the reuptake of serotonin and norepinephrine in the brain. This means that ziprasidone acts in a way that makes it difficult for these hormones to be used by our neurons.
In the mesolimbic pathway, it generates the excess of dopamine that generates positive symptoms (in the sense that they add elements to the subject’s behavior), such as hallucinations and delusions, to be reduced.
Although this drug generates the same effect throughout the brain as in the mesolimbic pathway, the fact that it also acts as an antagonist of serotonin (which is an inhibitor of dopamine secretion) causes dopamine levels in other areas to be maintained. or even increase in some points such as the bark. This results in fewer side effects and that there may be an improvement in negative symptoms (poverty of thought being one of the most characteristic), which is linked to low levels of dopamine at the mesocortical level.
What is this psychotropic drug used for?
There are different disorders in which the use of ziprasidone can generate beneficial effects Among these different applications and indications we can find the following.
Schizophrenia and other psychotic disorders
The best known and most frequent indication for ziprasidone is that corresponding to schizophrenia and other psychotic disorders being effective in reducing positive symptoms and also having an effect on negative symptoms while generating fewer secondary symptoms than typical antipsychotics.
Another indication for ziprasidone is the treatment of bipolar disorder, specifically manic attacks in bipolar type I disorder. This medication allows the reduction of manic symptoms such as hyperactivity, distractibility, sense of grandiosity aggression or agitation.
Side effects and risks
Like all psychotropic drugs, ziprasidone, although it is an effective medication, can cause a series of unpleasant side effects and potential risks.
As with other antipsychotics, ziprasidone may cause symptoms such as abdominal pain, fever, edema, hypersensitivity to light, hypothermia, hypertension, tachycardia, increased cholesterol, weight gain, nausea and vomiting, some extrapyramidal motor symptoms such as dyskinesia. lateness and tremors, pneumonia. Sedation is another common secondary symptom, along with weakness and dizziness
It can also cause sexual symptoms such as erectile dysfunction, menstruation disorders, gynecomastia, galactorrhea, delusions, gait problems, incoordination, anemia, jaundice, arrhythmias and heart problems. In some cases it may be necessary to go to medical services immediately, such as in the presence of seizures, falls, priapism, loss of consciousness, muscle rigidity or arrhythmias.
Another risk to take into account is shared with all antipsychotics: the possibility of suffering from a neuroleptic malignant syndrome that can end in the death of the patient. Although the risks of this problem appearing are low, it is necessary to control them, It is essential to control the doses that are prescribed and supplied to the patient (process always supervised by doctors).
Contraindications
Ziprasidone is a powerful and very effective drug that cannot be used at all times or in certain types of people as it poses a possible health risk. This contraindicated in people who have suffered from some type of cardiac problem or disorder Also in those elderly people who suffer from dementia, since it increases the risk of death.
Special care must be taken with the interaction with other medications, as well as alcohol consumption. Its use is also not recommended in diabetic patients, with liver or kidney problems, people with epilepsy or seizures, breast cancer or spinal/blood problems. Finally, not during pregnancy or breastfeeding. In case of pregnancy, you must consult with your doctor about the possibility of changing the type of medication.
Comparison with other antipsychotics
As we have seen, there are numerous antipsychotics, and comparisons have been made between them to verify their effectiveness.
In some studies and systematic reviews, it has been found that although highly effective, ziprasidone appears to be slightly less effective than other atypical antipsychotics such as olanzapine or risperidone. However, also has been shown to be less likely to cause side effects
Specifically, the subjects analyzed had a lower tendency to gain weight with the medication and a lower tendency to raise cholesterol. Although in comparison with olanzapine it generated a greater probability of extrapyramidal symptoms and in relation to quetiapine an increase in prolactin (and therefore a greater number of sexual symptoms), in both cases it produced a lower level of these symptoms compared to risperidone. Despite this, the investigations found that the abandonment of the studies by the participants caused these data to be biased.
