ABSTRACT
OBJECTIVE: Authors evaluated the safety of intramuscular ziprasidone for use in acute agitation in an elderly population. METHOD: Medical records were reviewed retrospectively to identify consecutive patients who were admitted to our neuropsychiatry service with the presenting complaint of dementia (DSM-IV) with agitation and who were given intramuscular ziprasidone and then administered an electrocardiogram (ECG) (N = 23). Some patients also had a baseline ECG (N = 14). QTc intervals were recorded, and significance was defined as a QTc of > or =450 ms or a 10% prolongation from baseline. A paired-samples t test was performed to compare the baseline and postmedication QTc intervals. Confounding factors were examined, and cardiac events (torsades de pointes, cardiac arrest) were recorded. RESULTS: There was no significant difference in the QTc interval between the baseline and the post-ziprasidone values. One patient had a QTc greater than 500 ms and 25% over baseline, and therefore the medication was discontinued. The mean prolongation of the QTc interval was only 0.5 ms. There were no episodes of torsades de pointes. Other medications that the patients were taking did not appear to affect the QTc interval in an expected manner. CONCLUSION: Larger studies need to be done to evaluate the safety of intramuscular ziprasidone in agitated elderly patients, a population with an increased risk of QT prolongation and torsades de pointes because of their age, comorbid conditions, and concomitant use of multiple medications.
Subject(s)
Antipsychotic Agents/administration & dosage , Antipsychotic Agents/adverse effects , Arrhythmias, Cardiac/chemically induced , Dementia/psychology , Piperazines/administration & dosage , Piperazines/adverse effects , Psychomotor Agitation/drug therapy , Thiazoles/administration & dosage , Thiazoles/adverse effects , Aged , Aged, 80 and over , Antipsychotic Agents/pharmacology , Arrhythmias, Cardiac/epidemiology , Dementia/drug therapy , Electrocardiography/drug effects , Female , Haloperidol/administration & dosage , Haloperidol/adverse effects , Humans , Injections, Intramuscular , Long QT Syndrome/chemically induced , Long QT Syndrome/diagnosis , Long QT Syndrome/epidemiology , Male , Middle Aged , Piperazines/pharmacology , Retrospective Studies , Risk Factors , Thiazoles/pharmacology , Torsades de Pointes/chemically induced , Torsades de Pointes/diagnosis , Torsades de Pointes/epidemiologyABSTRACT
OBJECTIVE: The objective of this study was to examine the association between psychoactive medications and sleep quality in a sample of nursing home patients. DESIGN: We studied a baseline data collection for a clinical trial of a nonpharmacologic sleep intervention program. SETTING: This study was conducted at six community nursing homes. PARTICIPANTS: We studied 168 nursing home patients. METHODS: Sleep was recorded by wrist actigraphy for three to five nights under usual care conditions. Demographic and clinical data were collected by medical record reviews and patient assessments. RESULT: One or more routine psychoactive medications were being taken by 109 (65%) of the patients. Number of minutes of sleep, percent of time in bed asleep, and number of awakenings did not differ between those receiving and not receiving a psychoactive medication. Neither the use of antidepressants nor the use of only psychoactive medications reported to cause sedation was associated with significantly better sleep quality. CONCLUSION: Psychoactive medications as a general class of drugs were not associated with better or worse sleep quality in this very frail nursing home population. The effect of individual classes of psychoactive drugs on sleep quality in this patient population requires further study.
