Ziprasidone versus haloperidol for the treatment of agitation

Abstract

Study objectives: We compare the efficacy of sequential intramuscular/oral ziprasidone versus intramuscular/oral haloperidol in the treatment of hostility and excitability. Methods: Post hoc analyses were conducted of pooled data from 2 studies in patients with acute schizophrenia or schizoaffective disorder comparing mean reductions in Brief Psychiatric Rating Scale (BPRS) hostility (item 10), excitability (item 17), and agitation factor (sum of items 2, 6, 10, and 17) scores during the first 7 days. In the first study (7 days), 90 patients received less than 3 days of intramuscular ziprasidone and then oral ziprasidone (80 to 200 mg/day, mean 90.5±44.9 mg/day), and 42 patients received intramuscular haloperidol and then oral haloperidol (10 to 80 mg/day, mean 14.0±10.1 mg/day). In the second study (6 weeks [42 days]), 417 patients received intramuscular ziprasidone and then oral ziprasidone (80 to 160 mg/day, mean 116±30.4 mg/day), and 133 patients received intramuscular haloperidol and then oral haloperidol (5 to 20 mg/day, mean 11.5±3.6 mg/day). Initial analyses using pooled data from the 7-day trial compared mean reductions in BPRS hostility and excitability items and agitation factor for ziprasidone versus haloperidol using mixed-model repeated measures analysis of variance. Specific antihostility effect was tested during the first 7 days (pooled data) and during 42 days (the 42-day study only) by accounting for general antipsychotic effect, akathisia, and sedation. Results: Overall, after 7 days, patients demonstrated improvement on the hostility item ( P =.004) and agitation factor ( P =.0001) of the BPRS. Ziprasidone was more effective than haloperidol on the excitability item ( P =.02) and agitation factor ( P =.01). Both drugs exhibited a specific antihostility effect. Conclusion: Although both treatments resulted in a specific antihostility effect, ziprasidone was superior to haloperidol in the treatment of excitability and agitation.