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Ziprasidone, or 5-[2-[4-(1,2-benzisothiazol-3-yl)-1-piperazinyl]ethyl]-6-chloro-1,3-dihydro-2H-indol-2-one, is a novel benzisothiazolylpiperazine antipsychotic (Figure 33–1) with a unique structure and combination of receptor- and transporter-binding properties that distinguish it from other atypical/second-generation antipsychotics (Table 33–1) (Richelson and Souder 2000; Shapiro et al. 2003; Weiner et al. 2004).

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FIGURE 33–1. Chemical structure of ziprasidone.

FIGURE 33–2. Histamine1 (H1) receptor affinity predicts antipsychotic-induced weight gain.ARI = aripiprazole; CLO = clozapine; HAL = haloperidol; K1 = binding affinity; OLA = olanzapine; QTP = quetiapine; RIS = risperidone; ZIP = ziprasidone.Source. Adapted from Kroeze et al. 2003.

FIGURE 33–3. Relationship between dopamine2 (D2) and serotonin2 (5-HT2) receptor occupancy and ziprasidone plasma levels in 16 patients with schizophrenia or schizoaffective disorder receiving therapeutic dosages of ziprasidone.Dotted straight lines represent minimal D2 receptor occupancy and plasma concentration that would be expected to be associated with a clinical antipsychotic response, corresponding to a ziprasidone dosage of approximately 120 mg/day.Source. Adapted from Mamo et al. 2004.
Table Reference Number
TABLE 33–1. Binding affinities of atypical antipsychotics (compared with haloperidol) for human receptors and rat transporters

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