From the FDA Drug Label
Atypical antipsychotic drugs have been associated with metabolic changes that may increase cardiovascular/cerebrovascular risk. These metabolic changes include hyperglycemia, dyslipidemia, and body weight gain. While all of the drugs in the class have been shown to produce some metabolic changes, each drug has its own specific risk profile There have been few reports of hyperglycemia or diabetes in patients treated with ziprasidone Although fewer patients have been treated with ziprasidone, it is not known if this more limited experience is the sole reason for the paucity of such reports
The antipsychotic medication with the least cardiovascular risks is not explicitly stated in the provided drug label. However, based on the information provided, ziprasidone may have a lower risk of cardiovascular events due to its lower incidence of hyperglycemia and diabetes mellitus compared to other atypical antipsychotics. Key points to consider:
- Metabolic changes: Atypical antipsychotics, including ziprasidone, can cause metabolic changes that increase cardiovascular risk.
- Hyperglycemia and diabetes: Ziprasidone has a lower incidence of hyperglycemia and diabetes compared to other atypical antipsychotics.
- Cardiovascular risk: The exact cardiovascular risk profile of ziprasidone is not fully understood, but its lower incidence of metabolic changes may indicate a lower risk. 1
From the Research
Lurasidone is generally considered to have the least cardiovascular risks among antipsychotic medications, with a lower risk of QT prolongation and metabolic side effects compared to other antipsychotics. According to a recent pharmacovigilance study 2, lurasidone was associated with the lowest risk of reporting QT prolongation, while sertindole, amisulpride, and ziprasidone were associated with a higher risk. This study used data from the World Health Organization's Global Individual Case Safety Reports database and found a positive correlation between the risk of reporting QT prolongation and affinity for the hERG channel.
The study found that lurasidone had a lower risk of QT prolongation compared to other antipsychotics, including ziprasidone, which was previously thought to have a favorable cardiovascular profile. The results of this study suggest that lurasidone may be a better option for patients at risk of cardiovascular disease, as it has a lower risk of QT prolongation and metabolic side effects.
Key points to consider when prescribing lurasidone include:
- Starting dose: 20-40 mg daily
- Titration: can be titrated up to 80 mg daily as needed
- Metabolic side effects: lurasidone has a lower risk of weight gain, diabetes, and dyslipidemia compared to other antipsychotics
- QT prolongation: lurasidone has a lower risk of QT prolongation compared to other antipsychotics, but baseline ECG monitoring is still recommended, especially in patients with pre-existing cardiac conditions or those taking other medications that may affect cardiac conduction.
Overall, lurasidone is a good option for patients who require antipsychotic treatment and are at risk of cardiovascular disease, due to its lower risk of QT prolongation and metabolic side effects compared to other antipsychotics 2.