Ziprasidone

Ziprasidone is a prescription medication used to treat Schizophrenia, Acute Agitation with Schizophrenia, and Bipolar I Disorder. 

• Ziprasidone is available under the following different brand names: Geodon.

Adult dosage

Capsule

• 20mg
• 40mg
• 60mg
• 80mg

Powder for injection

• 20mg

Schizophrenia 

Adult dosage

• 20 mg orally every 12 hours with food initially; may be increased every other day as needed; not to exceed 80 mg every 12 hours

Acute Agitation with Schizophrenia

Adult dosage

• IM: 10 mg every 2 hours or 20 mg every 4 hours; not to exceed 40 mg/day; use IM for up to 3 days, and switch to oral if continuing past this time

Bipolar I Disorder

Adult dosage

• Acute treatment: 40 mg orally every 12 hours with food initially; on day 2, may be increased if necessary to 60-80 mg orally every 12 hours; adjust the dose according to tolerance and efficacy within range of 40-80 mg every 12 hours

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Ziprasidone include:

• dizziness, 
• drowsiness, 
• weakness, 
• headache, 
• nausea, 
• vomiting, 
• trouble swallowing, 
• weight gain, 
• restlessness, 
• tremors, 
• involuntary muscle movements, 
• vision problems, 
• runny nose, and
• new or worsening cough

Serious side effects of Ziprasidone include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• fever, 
• sore throat, 
• burning sensation in the eyes, 
• skin pain, 
• red or purple skin rash that spreads and causes blistering and peeling, 
• skin rash, 
• swollen glands, 
• muscle aches, 
• severe weakness, 
• unusual bruising, 
• yellowing of the skin or eyes, 
• fast or pounding heartbeats, 
• fluttering in the chest, 
• shortness of breath, 
• sudden dizziness, 
• uncontrolled muscle movements in the face (chewing, lip-smacking, frowning, tongue movement, blinking or eye movement), 
• any skin rash (no matter how mild), 
• mouth sores, 
• skin sores, 
• sore throat, 
• cough, 
• trouble breathing, 
• increased thirst, 
• increased urination, 
• dry mouth, 
• fruity breath odor, 
• very stiff (rigid) muscles, 
• high fever, 
• sweating, 
• confusion, and
• agitation

Rare side effects of Ziprasidone include:

• none 

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Ziprasidone has severe interactions with at least 18 other drugs. 
• Ziprasidone has serious interactions with at least 98 other drugs. 
• Ziprasidone has moderate interactions with at least 346 other drugs. 
• Ziprasidone has minor interactions with at least 63 other drugs. 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Documented hypersensitivity 
• Any drugs or conditions that prolong QT interval
• Recent acute myocardial infarction
• Uncompensated heart failure

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Ziprasidone?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Ziprasidone?”

Cautions

• Seizure disorders; may cause hypotension, EPS, somnolence, and sensory instability, which could lead to falls and, consequently, fractures or other injuries; for patients with diseases, conditions, or medications that could exacerbate these effects, complete fall risk assessments when initiating antipsychotic treatment and recurrently for patients on long-term antipsychotic therapy
• Atypical antipsychotics have been associated with metabolic changes (eg, hyperglycemia, dyslipidemia, and body weight gain) that may increase cardiovascular/cerebrovascular risk
• Hyperglycemia may occur and in some cases may be extreme, resulting in ketoacidosis, hyperosmolar coma, or death; monitor blood glucose of high-risk patients
• Neuroleptic malignant syndrome reported with antipsychotic drugs
• Tardive dyskinesia, acute dystonic reactions, pseudoparkinsonism, or akathisia may develop acutely or chronically
• Discontinue if rash develops without an identified cause
• Drug reaction with eosinophilia and systemic symptoms (DRESS) reported; DRESS consists of a combination of three or more of the following: cutaneous reaction (such as rash or exfoliative dermatitis), eosinophilia, fever, lymphadenopathy, and one or more systemic complications such as hepatitis, nephritis, pneumonitis, myocarditis, and pericarditis; DRESS is sometimes fatal; discontinue therapy if DRESS suspected
• Cutaneous adverse reactions, such as Stevens-Johnson syndrome, reported; severe cutaneous adverse reactions are sometimes fatal; discontinue therapy if suspected
• Rare cases of priapism reported
• FDA warning regarding off-label use for dementia in elderly (see Black Box Warnings)
• May cause orthostatic hypotension
• Suicide attempt is inherent in psychotic illness or bipolar disorder, close supervision of high-risk patients should accompany drug therapy
• Dopamine2 antagonists may elevate prolactin levels; long-standing hyperprolactinemia, when associated with hypogonadism, may lead to decreased bone density
• Leukopenia/neutropenia and agranulocytosis were reported; possible risk factors for leukopenia/neutropenia include pre-existing low white blood cell (WBC) count and a history of drug-induced leukopenia/neutropenia
• If the patient has a history of clinically significant low WBC count or drug-induced leukopenia/neutropenia, monitor complete blood count (CBC) frequently during the first few months of therapy; discontinue the drug at the first sign of clinically significant WBC declined below 1000/μL in absence of other causative factors, and continue monitoring WBC count until recovery
• Antipsychotic agents have been associated with esophageal dysmotility and aspiration; use caution in patients at risk of pneumonia
• May cause QTc prolongation, which has been associated with the development of malignant ventricular arrhythmias (torsade de pointes) and sudden death; discontinue therapy in patients with persistent QTc intervals over 500 msec; avoid hypokalemia or hypomagnesemia
• Moderate to highly sedative; use caution when required to operate heavy machinery
• May cause core body temperature regulation impairment; use caution with heat exposure, strenuous exercise, dehydration, or taking medications with anticholinergic effects
• Make electrolyte imbalance corrections, especially hypomagnesemia or hypokalemia before and throughout therapy
• Use with caution in hepatic impairment

Pregnancy and Lactation

• There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to atypical antipsychotics, during pregnancy; healthcare providers are encouraged to register patients by contacting the National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or online at http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry
• Neonates exposed to antipsychotic drugs, during the third trimester are at risk for extrapyramidal and/or withdrawal symptoms, following delivery; overall available data from published epidemiologic studies of pregnant women have not established a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes; there are risks to mother associated with untreated schizophrenia or bipolar I disorder and with exposure to antipsychotics, during pregnancy
• There is a risk to the mother from untreated schizophrenia or bipolar I disorder, including increased risk of relapse, hospitalization, and suicide
• Schizophrenia and bipolar I disorder are associated with increased adverse perinatal outcomes, including preterm birth; it is not known if this is a direct result of illness or other comorbid factors
• Extrapyramidal and/or withdrawal symptoms, including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorder have been reported in neonates exposed to the drug, during the third trimester of pregnancy; these symptoms have varied in severity; monitor neonates for extrapyramidal and/or withdrawal symptoms and manage symptoms appropriately; some neonates recovered within hours or days without specific treatment; others required prolonged hospitalization. 

Lactation

• Limited data from a published case report indicate the presence of drugs in human milk; although there are no reports of adverse effects on a breastfed infant exposed to the drug via breast milk, there are reports of excess sedation, irritability, poor feeding, and extrapyramidal symptoms (tremors and abnormal muscle movements) in infants exposed to other atypical antipsychotics through breast milk
• There is no information on the effects of drugs on milk production; developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for drug and any potential adverse effects on the breastfed child from the drug or mother’s underlying condition
• Infants exposed to the drug should be monitored for excess sedation, irritability, poor feeding, and extrapyramidal symptoms (tremors and abnormal muscle movements).