Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy.
Postgrad Med. 2011 Jan;123(1):135-59. doi: 10.3810/pgm.2011.01.2255.
This article addresses points to consider when switching patients to the second-generation antipsychotic (SGA), ziprasidone, in everyday clinical practice: 1) the pharmacologic properties of the pre-switch antipsychotic and of ziprasidone; 2) switch and dosing strategies to ensure maintenance or attainment of efficacy; 3) recognition and management of possible rebound effects of the pre-switch medication discontinuation; 4) recognition and management of potential side effects of ziprasidone; and 5) education and support for patients/caregivers concerning correct ziprasidone administration.
A Medline search (up to July 7, 2010) identified studies in which adult patients with schizophrenia were switched to ziprasidone from another antipsychotic. In addition, based on their extensive clinical experience, an expert faculty of European psychiatrists provided advice on identifying patients who may be appropriate candidates for switching to ziprasidone, and on establishing optimal strategies for switching to ziprasidone in everyday clinical practice.
Data from 10 studies, in which 1395 patients were switched to ziprasidone, showed that switching from first-generation antipsychotics (FGAs) or SGAs generally resulted in maintenance or improvement of efficacy across all studied symptom domains, improvements in tolerability, and acute and long-term benefits regarding cardiometabolic parameters, including body weight. Maintenance of efficacy is most likely to be achieved using a plateau cross-titration strategy, with a rapid uptitration of ziprasidone to a dose range of 60 to 80 mg administered twice daily with food. Temporary coadministration of benzodiazepines, anticholinergics, or beta-blockers should be considered for the management of potential rebound effects.
Optimal switching of patients with schizophrenia from FGAs or SGAs to ziprasidone requires careful attention to differences in the pharmacological profiles of the pre-switch medication and of ziprasidone, which may impact efficacy and tolerability. Good communication between the clinician and patient/caregiver about the goals of switching, the importance of adherence to the chosen switch strategy, and the correct administration of ziprasidone are essential.
本文讨论了在日常临床实践中将患者转换为第二代抗精神病药（SGA）-齐拉西酮时需要考虑的几点：1）转换前抗精神病药和齐拉西酮的药理学特性；2）确保维持或达到疗效的转换和剂量策略；3）识别和管理停用转换前药物可能出现的反弹效应；4）识别和管理齐拉西酮的潜在副作用；5）向患者/护理人员提供有关正确使用齐拉西酮的教育和支持。
通过 Medline 检索（截至 2010 年 7 月 7 日），确定了将成人精神分裂症患者从另一种抗精神病药转换为齐拉西酮的研究。此外，根据他们丰富的临床经验，一组来自欧洲的精神病学专家就识别可能适合转换为齐拉西酮的患者以及在日常临床实践中建立最佳的转换为齐拉西酮策略提供了建议。
来自 10 项研究的数据表明，从第一代抗精神病药（FGAs）或第二代抗精神病药（SGAs）转换为齐拉西酮通常会导致所有研究症状领域的疗效维持或改善，改善耐受性，并在急性和长期的心血管代谢参数方面带来益处，包括体重。最有可能通过平台交叉滴定策略实现疗效维持，即快速将齐拉西酮滴定至每日两次、每次 60 至 80mg 并随餐服用的剂量范围。应考虑临时联合使用苯二氮䓬类药物、抗胆碱能药物或β-受体阻滞剂，以管理潜在的反弹效应。
将精神分裂症患者从 FGAs 或 SGAs 最佳转换为齐拉西酮需要仔细注意转换前药物和齐拉西酮的药理学特征差异，这可能会影响疗效和耐受性。临床医生与患者/护理人员之间关于转换目标、坚持选择的转换策略的重要性以及正确使用齐拉西酮的良好沟通至关重要。
