Ziprasidone: Evaluating the reconstitution of intramuscular ziprasidone (Geodon) into solution at The Medical Dictionary
Evaluating the reconstitution of intramuscular ziprasidone (Geodon) into solution.
Ewing JD, Rund DA, Votolato NA. Ann Emerg Med 2004; 43(3): 419-420.
The authors are affiliated with either the Department of Emergency Medicine orthe Department of Psychiatry, Ohio State University, Columbus, Ohio. Often, agitated psychiatric patients making emergency room (ER) visits require chemical restraint. If it is not possible forthem to receive oral medication, intramuscular (IM) haloperidol or a combination of haloperidol and lorazepam have been administered. Recently developed atypical antipsychotics have demonstrated advantages over the older typical antipsychotics. Currently, the only atypical antipsychotic marketed for IM administration is ziprasidone (Geodon by Pfizer). The ziprasidone comes as a powder in a glass vial and must be reconstituted with 1.2 mLof sterile water; the recommended IM dose is usually 1 mL (20 mg). Instructions provided by the manufacturer state that the powder and sterile water in the glass vial must be shaken until a colorless to pale-pink solution is observed. As the manufacturer does not provide information on how long the shaking will take, the authors experimented with 16 vials; eight were reconstituted using a commercial agitator, and the other eight were shaken manually. The mean reconstitution time using the agitator was 5.6875 minutes (Â± 0.53 minutes), and the mean reconstitution time using manual shaking was 2.875 minutes (Â± 0.3535 minutes). In their admittedly preliminary study, the authors found reconstitution by shaking by hand to be quicker but possibly still taking too long in some ER situations. If regular use of IM ziprasidone is anticipated, other options are to store the reconstituted ziprasidone out of sunlight at room temperature [15 to 3OÂ°C (59 to 86Â°F)] for 24 hours or in a refrigerator [2 to 8Â°C (35.6 to 46.4Â°F)] for up to 7 days.