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Ziprasidone

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Ziprasidone, Geodon

  • See Also
  1. Antipsychotic Medication
  2. Psychosis
  • Indications
  1. Schizophrenia (including acute episodic Agitation)
  2. Mania
  3. Bipolar Disorder
  4. Tourette's Syndrome (not FDA approved)
  • Mechanism
  1. Primarily a Serotonin 2A Antagonist (Dopamine D2 Antagonist activity is much less)
  • Class
  1. Atypical Antipsychotic (Second Generation agent)
  1. Oral
    1. Start: 20 mg orally twice daily taken with meals (at least 500 kcal)
    2. Titrate dose as often as every 2-3 days to effective dose twice daily
    3. Maximum: 80 mg orally twice daily
  2. Parenteral (acute Agitation)
    1. Ziprasidone 10 to 20 mg IM
    2. May repeat 10 mg every 2 hours (or 20 mg every 4 hours) up to cummulative maximum of 40 mg/day
    3. Maximum: 40 mg/day
  1. Start 40 mg orally twice daily taken with meals (at least 500 kcal)
  2. May increase to 60 to 80 mg orally twice daily after the first 1-2 days
  3. Target dose: 40 to 80 mg orally twice daily
  4. Maximum: 80 mg orally twice daily
  • Advantages
  1. Minimal weight gain than with other Atypical Antipsychotics
  2. Lower risk of diabetes than with other Atypical Antipsychotics
  • Drug Interactions
  1. Must be taken with meals of at least 500 kcals to ensure adequate absorption
  2. Metabolized by CYP3A4
  3. Increase Antipsychotic levels (toxicity risk): Monitor for toxicity
    1. Clarithromycin
    2. Erythromycin
    3. Grapefruit juice
    4. Fluconazole
    5. Itraconazole
    6. Ketoconazole
  4. Decrease Antipsychotic levels (lower efficacy)
    1. Carbamazepine
    2. Phenytoin
  • Adverse Effects
  1. Lower Extrapyramidal Side Effects compared with other Antipsychotics
  2. Somnolence (esp. Overdose)
  3. Nausea
  4. Weakness
  5. May increase Serum Prolactin
  6. QTc Prolongation (more than with other Atypical Antipsychotics, but no increased mortality)
    1. Strom (2011) Am J Psychiatry 168:193 [PubMed]
  7. DRESS Syndrome (rare)
    1. Chan (2015) J Clin Psychiatry 76:e1138 [PubMed]
  • Safety
  1. Pregnancy Category C
  2. Avoid in Lactation
  • Monitoring
  1. See Antipsychotics
  • Resources
  1. Ziprasidone (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f603f66e-26fd-486c-b477-8d1c6cccfd44
  • References
  1. (2016) Med Lett Drugs Ther 58(1510): 160-5
  2. Glauser and Peters (2016) Crit Dec Emerg Med 30(4): 17-27
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  4. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 42-3