Zusammenfassung
Ziprasidon ist ein neues Antipsychotikum, dass z. T. über das Zytochrom-P450-Isoenzym
CYP3A4 metabolisiert wird. In der Kasuistik wird ein 70-jähriger Patient dargestellt,
der unter der Kombination von Quetiapin und Ziprasidon eine deutliche Verlängerung
der QTc-Zeit auf 482 ms mit kardialen Komplikationen in Form von Extrasystolen zeigte.
Nach Absetzen von Quetiapin wurde wieder eine QTc-Zeit im Normbereich (428 ms) gemessen.
Zusammenfassend gehen wir von einer pharmakokinetischen Interaktion aus, da Ziprasidon
und Quetiapin über denselben Metabolisierungsweg des CYP3A4-Enzyms abgebaut werden.
Aus diesem Grund sollte die Kombination dieser beiden Antipsychotika vermieden werden.
Abstract
Background: Ziprasidone, a novel antipsychotic agent for the treatment of schizophrenia, undergoes
partial metabolism by cytochrome P450 3A4. It is associated with moderate prolongation
of QT interval, but no increased risk for ventricular tachyarrhythmia or sudden death
was demonstrated. Case report: A 70-year-old male was initiated on quetiapine therapy for an acute exacerbation
of chronic schizophrenia. The baseline electrocardiogram (ECG) showed a normal QT
interval (QTc: 417 ms). In combination therapy of quetiapine and ziprasidone the patient
developed suddenly cardiac arrhythmia with extrasystoles and the ECG revealed a prolonged
QTc interval of 482 ms. After breaking off treatment with quetiapine and reduction
of ziprasidone a normalized QT interval (QTc: 428 ms) was measured. Conclusions: We suppose a potential of pharmacokinetic interaction between quetiapine and ziprasidone
because of the same metabolic pathway by CYP3A4. Combining treatment of quetiapine
and ziprasidone is therefore contraindicated. In addition we suggest caution using
ziprasidone with any potential 3A4 substrate or inhibitor.
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FDA Psychopharmacological Drugs Advisory. Committee Hearing July 19, 2000
Christo Minov
Bezirkskrankenhaus Augsburg
Dr.-Mack-Straße 1
86156 Augsburg
