Effects of Oral Ziprasidone and Oral Haloperidol on QTc Interval in Patients with Schizophrenia or Schizoaffective Disorder

• Published in: Pharmacotherapy 2010-02, Vol.30 (2), p.127-135
• Main Authors: Miceli, Jeffrey J., Tensfeldt, Thomas G., Shiovitz, Thomas, Anziano, Richard, O'Gorman, Cedric, Harrigan, Rachel H.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adult; Adult and adolescent clinical studies; antipsychotic; Antipsychotic Agents - administration & dosage; Antipsychotic Agents - adverse effects; Antipsychotic Agents - pharmacokinetics; Biological and medical sciences; Confidence intervals; Dose-Response Relationship, Drug; drug concentration; Drug dosages; Drug therapy; Electrocardiography - drug effects; Female; haloperidol; Haloperidol - administration & dosage; Haloperidol - adverse effects; Haloperidol - pharmacokinetics; Humans; Male; Medical sciences; Middle Aged; Patients; Pharmacology. Drug treatments; Piperazines - administration & dosage; Piperazines - adverse effects; Piperazines - pharmacokinetics; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Psychotic Disorders - drug therapy; Psychotropic drugs; QTc interval; Schizophrenia; Schizophrenia - drug therapy; Thiazoles - administration & dosage; Thiazoles - adverse effects; Thiazoles - pharmacokinetics; ziprasidone
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1592/phco.30.2.127

Study Objective. To characterize the effect of oral ziprasidone and haloperidol on the corrected QT (QTc) interval under steady‐state conditions. Design. Prospective, randomized, open‐label, parallel‐group study. Setting. Inpatient clinical research facility. Patients. Fifty‐nine adults (age range 25–59 yrs) with schizophrenia or schizoaffective disorder who had no clinically significant abnormality on electrocardiogram (ECG) at screening. Intervention. During period 1 (days −10 to −4), antipsychotic and anticholinergic drugs were tapered. On the first day (day −3) of period 2, the drugs were discontinued, and placebo was given for the next 3 days (days −2 to 0). On the last day (day 0) of period 2, serial baseline ECGs were collected. During period 3 (days 1–16), patients received escalating oral doses of ziprasidone and haloperidol to reach steady state. Period 4 (days 17–19) allowed for study drug washout and initiation of outpatient antipsychotic therapy; safety assessments were also performed during this period. Measurements and Results. At each steady‐state dose level, three ECGs and a serum or plasma sample were collected at the predicted time of peak exposure to the administered drug. Point estimates and 95% confidence intervals (CIs) were determined for the mean QTc interval at baseline and for the mean change from baseline in QTc at each steady‐state dose level. Mean changes from baseline in the QTc interval (msec) for ziprasidone were 4.5 (95% CI 1.9‐7.1), 19.5 (95% CI 15.5–23.4), and 22.5 (95% CI 15.7‐ 29.4) for steady‐state doses of 40, 160, and 320 mg/day, respectively; for haloperidol, −1.2 (95% CI −4.1‐1.7), 6.6 (95% CI 1.6–11.7), and 7.2 (95% CI 1.4–13.1) for steady‐state doses of 2.5, 15, and 30 mg/day. Although no patient in either treatment group experienced a QTc interval of 450 msec or greater, the QTc interval increased 30 msec or more in 11 and 17 ziprasidone‐treated patients at 160 and 320 mg/day, respectively, and in 3 and 5 haloperidol‐treated patients at 15 and 30 mg/day, respectively. Most treatment‐emergent adverse drug reactions were mild in intensity, and none were severe. Conclusion. The QTc interval in ziprasidone‐and haloperidol‐treated patients increased with dose. Treatment with high doses of ziprasidone or haloperidol did not result in any patient experiencing a QTc interval of 450 msec or greater.