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The use of ziprasidone in clinical practice: Analysis of pharmacokinetic and pharmacodynamic aspects from data of a drug monitoring survey

Published online by Cambridge University Press:  16 April 2020

Friederike Vogel ,
Reinhard Gansmüller ,
Thomas Leiblein ,
Otto Dietmaier ,
Hans Wassmuth ,
Gerhard Gründer  and
Christoph Hiemke
Friederike Vogel
Affiliation:
Department of Psychiatry and Psychotherapy, University of Mainz, Mainz, Germany
Reinhard Gansmüller
Affiliation:
Department of Psychiatry and Psychotherapy, University of Mainz, Mainz, Germany
Thomas Leiblein
Affiliation:
Department of Psychiatry and Psychotherapy, University of Mainz, Mainz, Germany
Otto Dietmaier
Affiliation:
Psychiatric Hospital, Klinikum am Weissenhof, D-74189Weinsberg, Germany
Hans Wassmuth
Affiliation:
Psychiatric Hospital, Klinikum am Weissenhof, D-74189Weinsberg, Germany
Gerhard Gründer
Affiliation:
Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany
Christoph Hiemke*
Affiliation:
Department of Psychiatry and Psychotherapy, University of Mainz, Mainz, Germany
*
*Corresponding author. Department of Psychiatry and Psychotherapy, University of Mainz, Untere Zahlbacher Street 8, D-55131 Mainz, Germany. Tel.: +49 6131 17 7131; fax: +49 6131 17 6789. E-mail address: [email protected] (C. Hiemke).
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Abstract

This study related clinical effects to daily doses and serum concentrations of ziprasidone by retrospective analysis of data from a therapeutic drug monitoring (TDM) survey established for patients treated with the new antipsychotic drug. In the total sample of 463 patients ziprasidone doses ranged between 20 and 320 mg/d and correlated significantly (r2 = 0.093, P < 0.01) with serum concentrations. The latter were highly variable within and between individual patients (between patients median 67 ng/ml, 25–75th percentile 40–103 ng/ml). Pharmacokinetic interactions with comedication played a minor role. According to the clinical global impressions (CGI) scale most of the 348 patients who were under antipsychotic monotherapy with ziprasidone were either much or very much improved (43.3 and 17.3%, respectively). The previously proposed therapeutic range of 50–130 ng/ml ziprasidone in serum or plasma, which can in effect be used interchangeable, was confirmed. In patients who were at least much improved and defined as “responders” mean serum concentrations of ziprasidone were 80 ng/ml and 78 ng/ml in patients who did not reach this improvement score. In patients with serum levels above or below 50 ng/ml, the number of responders was 66 or 63%, respectively. The difference between the two groups was not significant (P = 0.375), and improvement or side effects did not correlate significantly (P > 0.05) with doses or serum levels. It is concluded that TDM of ziprasidone may be useful for treatment optimization because of highly variable serum concentrations resulting under therapeutically recommended doses of the drug.

Keywords

ZiprasidoneTherapeutic drug monitoringSchizophreniaPlasma concentrationDrug interactions
Type
Original article
Information
European Psychiatry , Volume 24 , Issue 3 , April 2009 , pp. 143 - 148
Copyright
Copyright © Elsevier Masson SAS 2009

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