Ziprasidone

Drug Levels and Effects:




Summary of Use during Lactation:


Because there is no published experience with ziprasidone during breastfeeding, other antipsychotic agents are preferred.


Drug Levels:


Maternal Levels.

In one woman, ziprasidone was started at 9 days postpartum (dosage not stated, but presumably at a low dose and titrated upward). Serum and milk concentrations were obtained 10 minutes before the morning dose every day for 16 days. By day 7 of therapy, the patient was taking 80 mg of ziprasidone twice daily. Ziprasidone was not detectable in milk until day 10 of therapy when the milk concentration was 11 mcg/L; thereafter, the milk concentrations were not quantifiable (<10 mcg/L).[1]

Infant Levels.

Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:


A woman took ziprasidone 40 mg andcitalopram60 mg daily throughout pregnancy and postpartum. She breastfed extensively, except for occasional formula feedings by others. At 6 months of age, a pediatrician found the infant to be healthy with normal growth and development.[2]


Possible Effects on Lactation:


Prolactin elevation and galactorrhea has occurred during ziprasidone treatment.[3][4][5][6] However, prolactin elevation might be more transient and less severe than with phenothiazines.[7][8][9] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.


Alternate Drugs to Consider:


Haloperidol,Olanzapine,Risperidone


References:


1. Schlotterbeck P, Saur R, Hiemke C et al. Low concentration of ziprasidone in human milk: a case report. Int J Neuropsychopharmacol. 2009;12:437-8. PMID:19203410
2. Werremeyer A. Ziprasidone andcitalopramuse in pregnancy and lactation in a woman with psychotic depression. Am J Psychiatry. 2009;166:1298. Letter. PMID:19884241
3. Jordan MP. Ziprasidone-associated galactorrhea in a female teenager. J Am Acad Child Adolesc Psychiatry. 2003;42(1):4-5. Letter. PMID:12500070
4. Kopecek M, Bares M, Mohr P. Ziprasidone-induced galactorrhea: a case report. Neuro Endocrinol Lett. 2005;26:69-70. PMID:15726024
5. Ramadan M, Khan A, Preskorn S. D2-blockade and possible ziprasidone-induced galactorrhea. Int Clin Psychopharmacol. 2005;20:113-4. PMID:15729088
6. Saldana SN, Delgado SV. Ziprasidone-associated galactorrhea in an adolescent female. J Child Adolesc Psychopharmacol. 2007;17:259-60. PMID:17489723
7. Maguire GA. Prolactin elevation with antipsychotic medications: mechanisms of action and clinical consequences. J Clin Psychiatry. 2002;63(suppl 4):56-62. PMID:11913677
8. Goodnick PJ, Rodriguez L, Santana O. Antipsychotics: impact on prolactin levels. Expert Opin Pharmacother. 2002;3:1381-91. PMID:12387684
9. Weiden PJ, Daniel DG, Simpson G, Romano SJ. Improvement in indices of health status in outpatients with schizophrenia switched to ziprasidone. J Clin Psychopharmacol. 2003;23:595-600. PMID:14624190



Substance Identification:




Substance Name:

Ziprasidone

CAS Registry Number:

146939-27-7

Drug Class:


  • Antipsychotic Agents


  • Administrative Information:




    LactMed Record Number:


    281


    Last Revision Date:


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