Parenteral Ziprasidone (Geodon) for Acute Agitation
Yes, there is a parenteral (intramuscular) formulation of Geodon (ziprasidone) available for the treatment of acute agitation in patients with schizophrenia. 1
Formulation Details
The intramuscular (IM) formulation of ziprasidone has the following characteristics:
- Available as ziprasidone mesylate for injection
- Supplied in single-dose vials containing 20 mg ziprasidone/mL when reconstituted
- Each mL contains 20 mg of ziprasidone and 4.7 mg of methanesulfonic acid solubilized by 294 mg of sulfobutylether β-cyclodextrin sodium (SBECD) 1
Clinical Applications
Ziprasidone IM is specifically FDA-approved for:
- Control of acute agitation in patients with schizophrenia 2
- Rapid management of agitation with onset of action within 15-30 minutes 3
Efficacy Profile
The intramuscular formulation has demonstrated:
- Significant and rapid reduction in agitation and improvement in psychotic symptoms 3
- Efficacy comparable or superior to IM haloperidol in controlling acute agitation 3
- Effective transition pathway to oral ziprasidone for continued treatment 3
- Particularly useful in emergency department settings for undifferentiated agitated patients 4
Safety Considerations
Key safety points include:
- Lower incidence of extrapyramidal symptoms compared to conventional antipsychotics 3
- Can be administered with benzodiazepines without significant adverse consequences 3
- Associated with QTc interval prolongation, though clinical significance appears limited 5
- Most common adverse events: insomnia, headache, and dizziness 3
Practical Advantages
The availability of both IM and oral formulations offers several benefits:
- Allows for seamless transition from acute management to maintenance therapy 2
- Provides treatment option for patients unable or unwilling to take oral medication 6
- Demonstrates efficacy in real-world settings with extreme agitation or recent substance use 3
- May reduce restraint time compared to conventional therapies 4
Clinical Guidance
When using ziprasidone IM for acute agitation:
- Standard dose is 10-20 mg IM, with 20 mg showing greater efficacy 4
- Can be repeated every 4-6 hours as needed 4
- Monitor for QTc prolongation, especially in patients with cardiac risk factors
- Consider as an alternative to conventional antipsychotics due to lower risk of movement disorders 7
The availability of both oral and injectable formulations makes ziprasidone a versatile option for managing acute agitation with a pathway to continued treatment once the acute episode resolves.