UMEM Educational Pearls

Takeaways

IM ziprasidone (Geodon) has a relatively quick onset of action with a half-life of 2-5 hours.  Although commonly used in adults, there has not been a study looking at an effective dose in pediatrics. Based on the study referenced, the suggested pediatric dose of ziprasidone is 0.2 mg/kg (max 20mg).

In-Depth

This is the first study looking at ziprasidone in the pediatric emergency department population.  This was a retrospective observational study of children 5-18 years old who were treated with IM ziprasidone.  40 patients received IM ziprasidone in a tertiary care pediatric emergency department between 2007-2015.  2/3 of the patients had ADHD and 1/3 had autism spectrum disorder.  Other diagnosis included post-traumatic stress disorder, bipolar disorder and intellectual disabilities.

68% of patients responded to the initial dose.  The initial dose was 0.19 +/- 0.1 mg/kg in the responder group and 0.13 +/- 0.06 mg/kg in the non-responder group.  Single doses ranged from 2.5 mg to 20 mg total.

No patients had respiratory depression.  Two patients had potential extra-pyramidal symptoms, but one was prior to ziprasidone administration and the other patient had baseline facial twitching with no documentation if there was a change after ziprasidone administration.

References

Nguyen T, Stanton J and Foster R.  Intramuscular Ziprasidone Dosing for Acute Agitation in the Pediatric Emergency Department: An observational Study.  Journal of Pharmacy Practice 1-4.  2017.