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Details

Stereochemistry ACHIRAL
Molecular Formula C21H21ClN4OS.CH4O3S
Molecular Weight 509.041
Optical Activity NONE
Defined Stereocenters 0 / 0
E/Z Centers 0
Charge 0

SHOW SMILES / InChI
Structure of ZIPRASIDONE MESYLATE ANHYDROUS

SMILES

CS(O)(=O)=O.ClC1=CC2=C(CC(=O)N2)C=C1CCN3CCN(CC3)C4=NSC5=C4C=CC=C5

InChI

InChIKey=LOQSYPGSAZUDJZ-UHFFFAOYSA-N
InChI=1S/C21H21ClN4OS.CH4O3S/c22-17-13-18-15(12-20(27)23-18)11-14(17)5-6-25-7-9-26(10-8-25)21-16-3-1-2-4-19(16)28-24-21;1-5(2,3)4/h1-4,11,13H,5-10,12H2,(H,23,27);1H3,(H,2,3,4)

HIDE SMILES / InChI

Description
Curator's Comment: description was created based on several sources, including https://effectivehealthcare.ahrq.gov/ehc/products/150/786/CER43_Off-LabelAntipsychotics_execsumm_20110928.pdf

Ziprasidone is atypical antipsychotic, approved by the U.S. Food and Drug Administration for the treatment of schizophrenia, and acute mania and mixed states associated with bipolar disorder. Intramuscilar injections of Ziprasidone are indicated for rapid control of the agitation in schizophrenic patients. Ziprasidone is used off-label for treatment of major depressive disorder, anxiety, obsessive compulsive disorder, borderline personality disorder. Ziprasidone functions as an antagonist at the D2, 5HT2A, and 5HT1D receptors, and as an agonist at the 5HT1A receptor.

Originator

Curator's Comment: # Pfizer

Approval Year

TargetsConditions

Conditions

ConditionModalityTargetsHighest PhaseProduct
Primary
GEODON

Approved Use

Ziprasidone hydrochloride capsule is an atypical antipsychotic. In choosing among treatments, prescribers should be aware of the capacity of ziprasidone hydrochloride capsule to prolong the QT interval and may consider the use of other drugs first.

Launch Date

2001
Primary
GEODON

Approved Use

Ziprasidone hydrochloride capsule is an atypical antipsychotic. In choosing among treatments, prescribers should be aware of the capacity of ziprasidone hydrochloride capsule to prolong the QT interval and may consider the use of other drugs first. Ziprasidone intramuscular is indicated for the treatment of acute agitation in schizophrenic patients for whom treatment with ziprasidone is appropriate and who need intramuscular antipsychotic medication for rapid control of the agitation. “Psychomotor agitation” is defined in DSM-IV as “excessive motor activity associated with a feeling of inner tension.”

Launch Date

2001
Cmax

Cmax

ValueDoseCo-administeredAnalytePopulation
51 ng/mL
20 mg single, oral
dose: 20 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
ZIPRASIDONE serum
Homo sapiens
population: UNHEALTHY
age: ADOLESCENT
sex: FEMALE / MALE
food status: FED
AUC

AUC

ValueDoseCo-administeredAnalytePopulation
457 ng × h/mL
20 mg single, oral
dose: 20 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
ZIPRASIDONE serum
Homo sapiens
population: UNHEALTHY
age: ADOLESCENT
sex: FEMALE / MALE
food status: FED
T1/2

T1/2

ValueDoseCo-administeredAnalytePopulation
4.1 h
20 mg single, oral
dose: 20 mg
route of administration: Oral
experiment type: SINGLE
co-administered:
ZIPRASIDONE serum
Homo sapiens
population: UNHEALTHY
age: ADOLESCENT
sex: FEMALE / MALE
food status: FED
Funbound

Funbound

ValueDoseCo-administeredAnalytePopulation
1%
ZIPRASIDONE plasma
Homo sapiens
population: UNKNOWN
age: UNKNOWN
sex: UNKNOWN
food status: UNKNOWN
Doses

Doses

DosePopulationAdverse events​
4480 mg single, oral
Overdose
Dose: 4480 mg
Route: oral
Route: single
Dose: 4480 mg
Co-administed with::
Clomethiazole(192 mg)
Sources:
unhealthy, 22 years
n = 1
Health Status: unhealthy
Condition: Paranoid Schizophrenia
Age Group: 22 years
Sex: M
Population Size: 1
Sources:
Disc. AE: Sedation, Hypotension...
AEs leading to
discontinuation/dose reduction:
Sedation (1 patient)
Hypotension (1 patient)
Sources:
20 mg single, oral
Overdose
Dose: 20 mg
Route: oral
Route: single
Dose: 20 mg
Sources:
healthy, 30 month
n = 1
Health Status: healthy
Age Group: 30 month
Sex: F
Population Size: 1
Sources:
Disc. AE: Respiratory depression...
AEs leading to
discontinuation/dose reduction:
Respiratory depression (1 patient)
Sources:
780 mg single, oral
Overdose
Dose: 780 mg
Route: oral
Route: single
Dose: 780 mg
Sources:
unhealthy, 31 years
n = 1
Health Status: unhealthy
Condition: Mixed personality disorder
Age Group: 31 years
Sex: M
Population Size: 1
Sources:
Disc. AE: Drowsiness...
AEs leading to
discontinuation/dose reduction:
Drowsiness (1 patient)
Sources:
1120 mg single, oral
Overdose
Dose: 1120 mg
Route: oral
Route: single
Dose: 1120 mg
Sources:
unhealthy, 35 years
n = 1
Health Status: unhealthy
Condition: Schizophrenia
Age Group: 35 years
Sex: M
Population Size: 1
Sources:
4400 mg single, oral
Overdose
Dose: 4400 mg
Route: oral
Route: single
Dose: 4400 mg
Co-administed with::
Clomethiazole(768 mg)
flunitrazepam(4 mg)
Sources:
unhealthy, 57 years
n = 1
Health Status: unhealthy
Condition: Manic-depressive disorder
Age Group: 57 years
Sex: F
Population Size: 1
Sources:
Disc. AE: Drowsiness, Tremor...
AEs leading to
discontinuation/dose reduction:
Drowsiness (1 patient)
Tremor (1 patient)
Anxiety (1 patient)
Sources:
20 mg 2 times / day steady, intramuscular
Studied dose
Dose: 20 mg, 2 times / day
Route: intramuscular
Route: steady
Dose: 20 mg, 2 times / day
Sources:
unhealthy, 60 – 81 years
n = 21
Health Status: unhealthy
Condition: Schizophrenia
Age Group: 60 – 81 years
Sex: M+F
Population Size: 21
Sources:
Other AEs: Blurred vision, Sedation...
Other AEs:
Blurred vision (1 patient)
Sedation (1 patient)
Sources:
40 mg 1 times / day steady, oral
Studied dose
Dose: 40 mg, 1 times / day
Route: oral
Route: steady
Dose: 40 mg, 1 times / day
Sources:
unhealthy, 7 – 17 years
n = 28
Health Status: unhealthy
Condition: Tourette's syndrome
Age Group: 7 – 17 years
Sex: M+F
Population Size: 28
Sources:
Other AEs: Somnolence, Akathisia...
Other AEs:
Somnolence (1 patient)
Akathisia (1 patient)
Sources:
20 mg single, oral
Dose: 20 mg
Route: oral
Route: single
Dose: 20 mg
Sources:
unhealthy, 7-16 years
n = 24
Health Status: unhealthy
Condition: Tourette's disorder or chronic tic disorder
Age Group: 7-16 years
Sex: M+F
Population Size: 24
Sources:
Other AEs: Somnolence, Syncope hypotensive...
Other AEs:
Somnolence (16 patients)
Syncope hypotensive (2 patients)
Sources:
AEs

AEs

AESignificanceDosePopulation
Hypotension 1 patient
Disc. AE
4480 mg single, oral
Overdose
Dose: 4480 mg
Route: oral
Route: single
Dose: 4480 mg
Co-administed with::
Clomethiazole(192 mg)
Sources:
unhealthy, 22 years
n = 1
Health Status: unhealthy
Condition: Paranoid Schizophrenia
Age Group: 22 years
Sex: M
Population Size: 1
Sources:
Sedation 1 patient
Disc. AE
4480 mg single, oral
Overdose
Dose: 4480 mg
Route: oral
Route: single
Dose: 4480 mg
Co-administed with::
Clomethiazole(192 mg)
Sources:
unhealthy, 22 years
n = 1
Health Status: unhealthy
Condition: Paranoid Schizophrenia
Age Group: 22 years
Sex: M
Population Size: 1
Sources:
Respiratory depression 1 patient
Disc. AE
20 mg single, oral
Overdose
Dose: 20 mg
Route: oral
Route: single
Dose: 20 mg
Sources:
healthy, 30 month
n = 1
Health Status: healthy
Age Group: 30 month
Sex: F
Population Size: 1
Sources:
Drowsiness 1 patient
Disc. AE
780 mg single, oral
Overdose
Dose: 780 mg
Route: oral
Route: single
Dose: 780 mg
Sources:
unhealthy, 31 years
n = 1
Health Status: unhealthy
Condition: Mixed personality disorder
Age Group: 31 years
Sex: M
Population Size: 1
Sources:
Anxiety 1 patient
Disc. AE
4400 mg single, oral
Overdose
Dose: 4400 mg
Route: oral
Route: single
Dose: 4400 mg
Co-administed with::
Clomethiazole(768 mg)
flunitrazepam(4 mg)
Sources:
unhealthy, 57 years
n = 1
Health Status: unhealthy
Condition: Manic-depressive disorder
Age Group: 57 years
Sex: F
Population Size: 1
Sources:
Drowsiness 1 patient
Disc. AE
4400 mg single, oral
Overdose
Dose: 4400 mg
Route: oral
Route: single
Dose: 4400 mg
Co-administed with::
Clomethiazole(768 mg)
flunitrazepam(4 mg)
Sources:
unhealthy, 57 years
n = 1
Health Status: unhealthy
Condition: Manic-depressive disorder
Age Group: 57 years
Sex: F
Population Size: 1
Sources:
Tremor 1 patient
Disc. AE
4400 mg single, oral
Overdose
Dose: 4400 mg
Route: oral
Route: single
Dose: 4400 mg
Co-administed with::
Clomethiazole(768 mg)
flunitrazepam(4 mg)
Sources:
unhealthy, 57 years
n = 1
Health Status: unhealthy
Condition: Manic-depressive disorder
Age Group: 57 years
Sex: F
Population Size: 1
Sources:
Blurred vision 1 patient
20 mg 2 times / day steady, intramuscular
Studied dose
Dose: 20 mg, 2 times / day
Route: intramuscular
Route: steady
Dose: 20 mg, 2 times / day
Sources:
unhealthy, 60 – 81 years
n = 21
Health Status: unhealthy
Condition: Schizophrenia
Age Group: 60 – 81 years
Sex: M+F
Population Size: 21
Sources:
Sedation 1 patient
20 mg 2 times / day steady, intramuscular
Studied dose
Dose: 20 mg, 2 times / day
Route: intramuscular
Route: steady
Dose: 20 mg, 2 times / day
Sources:
unhealthy, 60 – 81 years
n = 21
Health Status: unhealthy
Condition: Schizophrenia
Age Group: 60 – 81 years
Sex: M+F
Population Size: 21
Sources:
Akathisia 1 patient
40 mg 1 times / day steady, oral
Studied dose
Dose: 40 mg, 1 times / day
Route: oral
Route: steady
Dose: 40 mg, 1 times / day
Sources:
unhealthy, 7 – 17 years
n = 28
Health Status: unhealthy
Condition: Tourette's syndrome
Age Group: 7 – 17 years
Sex: M+F
Population Size: 28
Sources:
Somnolence 1 patient
40 mg 1 times / day steady, oral
Studied dose
Dose: 40 mg, 1 times / day
Route: oral
Route: steady
Dose: 40 mg, 1 times / day
Sources:
unhealthy, 7 – 17 years
n = 28
Health Status: unhealthy
Condition: Tourette's syndrome
Age Group: 7 – 17 years
Sex: M+F
Population Size: 28
Sources:
Somnolence 16 patients
20 mg single, oral
Dose: 20 mg
Route: oral
Route: single
Dose: 20 mg
Sources:
unhealthy, 7-16 years
n = 24
Health Status: unhealthy
Condition: Tourette's disorder or chronic tic disorder
Age Group: 7-16 years
Sex: M+F
Population Size: 24
Sources:
Syncope hypotensive 2 patients
20 mg single, oral
Dose: 20 mg
Route: oral
Route: single
Dose: 20 mg
Sources:
unhealthy, 7-16 years
n = 24
Health Status: unhealthy
Condition: Tourette's disorder or chronic tic disorder
Age Group: 7-16 years
Sex: M+F
Population Size: 24
Sources:
OverviewDrug as perpetrator​

Drug as perpetrator​

TargetModalityActivityMetaboliteClinical evidence
no [IC50 >100 uM]
no [IC50 >100 uM]
no [IC50 >100 uM]
no [IC50 >133 uM]
no [IC50 >133 uM]
no [IC50 >133 uM]
no [IC50 >133 uM]
no
yes [IC50 5.8 uM]
no (co-administration study)
Comment: Estimated Cfree,plasma = 0.29-0.73 nM (80mg BID); Coadministration of Ziprasidone had no effect on the urinary Dextromethorphan/Dextrophan ratio.
Page: 16, (ClinPharm) 16, (ClinPharm4) 58-60
yes [Ki 64 uM]
Drug as victim

Drug as victim

TargetModalityActivityMetaboliteClinical evidence
likely
major
yes (co-administration study)
Comment: Ketoconazole inhibited formation of Ziprasidone sulfoxide by 77% in vitro.; Coadministration of Ketoconazoke (strong CYP3A4 inhibitor) increased Ziprasidone AUC and Cmax by about 30%. Coadministration of Carbamazepine (strong CYP3A4 inducer) decreased Ziprasidone AUC by 36% and Cmax by 27%.
Page: 15-16, (ClinPhar) 15-16, (ClinPharm3) 65-66, (ClinPharm4) 35-38, 64-66
minor
yes
Tox targets

Tox targets

TargetModalityActivityMetaboliteClinical evidence
PubMed

PubMed

TitleDatePubMed
Review of atypical antipsychotics and weight gain.
2001
Emerging options in the treatment of bipolar disorders.
2001
Tourette syndrome: clinical characteristics and current management strategies.
2001
Atypical antipsychotics: new directions and new challenges in the treatment of schizophrenia.
2001
Ziprasidone in the short-term treatment of patients with schizoaffective disorder: results from two double- blind, placebo-controlled, multicenter studies.
2001 Feb
Cost effectiveness of the newer atypical antipsychotics: a review of the pharmacoeconomic research evidence.
2001 Jan
Intramuscular ziprasidone, 2 mg versus 10 mg, in the short-term management of agitated psychotic patients.
2001 Jan
Generalization of serotonin (5-HT)1A agonists and the antipsychotics, clozapine, ziprasidone and S16924, but not haloperidol, to the discriminative stimuli elicited by PD128,907 and 7-OH-DPAT.
2001 Jun
Intramuscular (IM) ziprasidone 20 mg is effective in reducing acute agitation associated with psychosis: a double-blind, randomized trial.
2001 May
New schizophrenia drug.
2001 May-Jun
Ziprasidone: profile on safety.
2001 Oct
Psychopharmacology news.
2001 Summer
Antipsychotic-related QTc prolongation, torsade de pointes and sudden death.
2002
Ziprasidone: a review of its use in schizophrenia and schizoaffective disorder.
2002
Advances in atypical antipsychotics for the treatment of schizophrenia: new formulations and new agents.
2002
Clinical significance of pharmacokinetic interactions between antiepileptic and psychotropic drugs.
2002
Ziprasidone induction of hypomania in depression?
2002 Apr
Priapism associated with two atypical antipsychotic agents.
2002 Aug
Case series: use of ziprasidone for maladaptive symptoms in youths with autism.
2002 Aug
Tardive dyskinesia and ziprasidone.
2002 Aug
Recent developments in pharmacotherapy for the acutely psychotic patient.
2002 Dec
Neuroleptic Malignant Syndrome with ziprasidone.
2002 Dec
Atypical antipsychotics: mechanism of action.
2002 Feb
Ziprasidone treatment of delirium.
2002 Jan-Feb
Brief report on Ziprasidone.
2002 Jul
Prolongation of QTc interval and antipsychotics.
2002 Jun
Schizophrenia: genesis, receptorology and current therapeutics.
2002 Mar
Validation of the behavioural activity rating scale (BARS): a novel measure of activity in agitated patients.
2002 Mar-Apr
Effects of typical and atypical antipsychotics and receptor selective compounds on acetylcholine efflux in the hippocampus of the rat.
2002 May
A 1-year, double-blind, placebo-controlled trial of ziprasidone 40, 80 and 160 mg/day in chronic schizophrenia: the Ziprasidone Extended Use in Schizophrenia (ZEUS) study.
2002 Sep
Cataract occurrence with antipsychotic drugs.
2002 Sep-Oct
Ziprasidone-associated galactorrhea in a female teenager.
2003 Jan
Constitutive coupling of a chimeric dopamine D2/alpha 1B receptor to the phospholipase C pathway: inverse agonism to silent antagonism by neuroleptic drugs.
2003 Jan
Patents

Sample Use Guides

For treatment of schizophrenia, GEODON capsules should be administered at an initial daily dose of 20 mg BID with food. Daily dosage may subsequently be adjusted on the basis of individual clinical status up to 80 mg BID. Systematic evaluation of ziprasidone has shown that its efficacy in schizophrenia is maintained for periods of up to 52 weeks at a dose of 20 to 80 mg BID. For treatment of bipolar mania, oral ziprasidone should be administered at an initial daily dose of 40 mg BID with food. The dose should then be increased to 60 mg or 80 mg BID on the second day of treatment and subsequently adjusted on the basis of toleration and efficacy within the range 40-80 mg BID. The recommended dose for intramuscular administration is 10 to 20 mg administered as required up to a maximum dose of 40 mg per day. Doses of 10 mg may be administered every two hours; doses of 20 mg may be administered every four hours up to a maximum of 40 mg/day.
Route of Administration: Other
In Vitro Use Guide
Standard receptor-binding methods were used to label dopamine D2 receptors using [3H]spiperone. Briefly, rats were sacrificed by decapitation and the brains rapidly removed. The corpus striatum was dissected and homogenized in 20 vol at 50 mM Tris HCl (pH 7.2) buffer using a Brinkman Polytron homogenizer (setting 7 for 15 s). The homogenate was centrifuged for 10 min at 40000g. The pellet was resuspended in fresh ice-cold 50 mM Tris (pH 7.2) buffer with the Polytron homogenizer and recentrifuged. The final pellet was resuspended in 50 mM Tris HCl buffer (pH 7.2) containing 1 mM MgCl2 and 100 mM NaCl. Assays were initiated by the addition of tissue to tubes containing [3H]spiperone (0.2 nM) and drug or buffer in a final volume of 1 mL. Blocking agents (500 nM cinanserin and 1 mM prazosin) were present to prevent [3H]spiperone from labeling 5-HT2 and R1 noradrenergic receptors. Nonspecific binding was defined as the radioligand bound in the presence of 10 uM (+)-butaclamol. After a 15 min incubation at 37 °C, tissue samples were filtered onto Whatman GF/B glass fiber filters using a Brandel harvester and rinsed two times with 5 mL of ice-cold 50 mM Tris HCl (pH 7.4) buffer. Filters were soaked in 10 mL of Ready-Safe (Beckman Instruments), and the radioactivity was quantified using liquid scintillation counting. Ziprasidone binds to D2 receptors with pKi of 8.32 nM.
Name Type Language
ZIPRASIDONE MESYLATE ANHYDROUS
Common Name English
Ziprasidone mesilate [WHO-DD]
Common Name English
2H-INDOL-2-ONE, 5-(2-(4-(1,2-BENZISOTHIAZOL-3-YL)-1-PIPERAZINYL)ETHYL)-6-CHLORO-1,3-DIHYDRO-, METHANESULFONATE (1:1)
Systematic Name English
ZIPRASIDONE MESILATE
WHO-DD  
Common Name English
2H-INDOL-2-ONE, 5-(2-(4-(1,2-BENZISOTHIAZOL-3-YL)-1-PIPERAZINYL)ETHYL)-6-CHLORO-1,3-DIHYDRO-, MONOMETHANESULFONATE
Systematic Name English
Code System Code Type Description
EVMPD
SUB20782
Created by admin on Sat Dec 16 04:40:28 GMT 2023 , Edited by admin on Sat Dec 16 04:40:28 GMT 2023
PRIMARY
SMS_ID
100000086716
Created by admin on Sat Dec 16 04:40:28 GMT 2023 , Edited by admin on Sat Dec 16 04:40:28 GMT 2023
PRIMARY
EPA CompTox
DTXSID80939920
Created by admin on Sat Dec 16 04:40:28 GMT 2023 , Edited by admin on Sat Dec 16 04:40:28 GMT 2023
PRIMARY
FDA UNII
VCY3F61S5R
Created by admin on Sat Dec 16 04:40:28 GMT 2023 , Edited by admin on Sat Dec 16 04:40:28 GMT 2023
PRIMARY
CAS
185021-64-1
Created by admin on Sat Dec 16 04:40:28 GMT 2023 , Edited by admin on Sat Dec 16 04:40:28 GMT 2023
PRIMARY
PUBCHEM
154068
Created by admin on Sat Dec 16 04:40:28 GMT 2023 , Edited by admin on Sat Dec 16 04:40:28 GMT 2023
PRIMARY