ziprasidone GEODON

Class: Second Generation Antipsychotic/​Benzisothiazole Derivative
FDA Indications: Schizophrenia, Bipolar Disorder
Off-Label Use: Delusional Parasitosis, MDD (adjunct), Agitation And Aggression In Dementia
Forms: 20, 40, 60, 80mg capsule; 20 mg/mL injectable
Dose Range: 40-200 mg/day
Starting: 20 mg bidwm for schizophrenia, 40 mg bidwm for acute mania; can ↑ dose q2 days up to 100 mg bid; for agitated psychosis use 10 mg IM Q2° or 20 mg IM Q4°, not to exceed 40 mg daily; GIVE WITH FOOD
Stopping: Taper 6-8 weeks, rapid d/c can lead to rebound psychosis

NAMI drug fact sheet

Contraindications: H/o prolonged QT; congenital long QT syndrome; recent MI; uncompensated heart failure; concurrent use of other QTc-prolonging agents
Serious Side Effects: , , , , QTc prolongation
Conditional Risk of TdP, Drugs to Avoid in Congenital Long QT
Side Effects: sedation/somnolence, EPS, headache, dizziness, nausea
1° MOA: 5HT2A–D2 antagonist
Target: Antagonism at: Partial agonist at Postsynaptic 5HT1A
t½: 6 (4-10)° TMAX: 6-8°
Substrate of: Aldehyde oxidase; 3A4, 1A2
Inhibits: ∅ ; Induces:
Active Metabolites:
  • - food ↑'s bioavailability up to 60%
  • - low propensity for inducing weight gain despite its significant affinity at histamine H1 and serotonin 5-HT2C receptors
  • - little association of ziprasidone with dyslipidemia, elevation of fasting triglycerides, or insulin resistance
  • - ∅ anticholinergic side effects
  • - causes a QTc increase of 15.9 ms, higher than other drugs in its class, clinical significance debatable but be aware of potential increased risk of TdP in light of QT prolongation risk factors
Special Populations

Category C—There are no adequate and well-controlled studies in pregnant women; GDM may be a problem with all SGAs; may cause extrapyramidal and/or withdrawal symptoms in neonates with third trimester exposure

RID 0.07-1.2%

All atypicals may increase mortality in elderly patients by 1.7 times greater than placebo. No dosage adjustment is recommended; consider initiating at a low end of the dosage range, with slower titration.

2019 BEE℞S Recommendation: Avoid, except in schizophrenia or bipolar disorder. Increased risk of CVA and greater rate of cognitive decline and mortality in persons with dementia. Avoid antipsychotics for behavioral problems of dementia or delirium unless nonpharmacological options have failed or are not possible and the older adult is threatening substantial harm to self or others.

No dosage adjustment necessary.

Undergoes extensive hepatic metabolism and systemic exposure may be increased; use with caution.


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Last updated February 29 2024 20:54:18. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.