Ziprasidone is an atypical antipsychotic medicine. It is used in the treatment of schizophrenia, manic phases of bipolar disorder and acute agitation[1]. It should not be used to treat symptoms of dementia in elderly patients. Before taking this medicine, consult your doctor, as this medicine interacts with other medications. It should also not be taken if you have heart problems.

Ziprasidone brand names

Ziprasidone is sold under the brand name Geodon.

What is ziprasidone prescribed for?

Ziprasidone is prescribed in the treatment of symptoms of schizophrenia in adults, acute agitation in schizophrenic patients, and bipolar mania[1].

It is used as a monotherapy for adults with manic or mixed episodes of bipolar disorder. It is also used as a maintenance treatment for bipolar patients, in addition to lithium or valproate.

It is sometimes used as an off-label monotherapy medication for acute hypomania, hyperactivity, and delirium in intensive care units.

How does ziprasidone work?

Ziprasidone is an atypical or second-generation antipsychotic. It works by restoring the balance of certain natural substances in our brain (dopamine and serotonin), thus improving thoughts, mood, and behavior.

How is ziprasidone usually taken?

Ziprasidone is taken orally and as an intramuscular injection. The dose depends on the patient's needs and their response to the treatment. Always make sure to follow your doctor’s instructions.

Oral intake: Ziprasidone is available in oral capsules of 20 mg, 40 mg, 60 mg, and 80 mg. 

Schizophrenic patients will usually be advised to take 20mg twice per day with meals. The maximum dose should not be over 160 mg per day, 80 mg twice per day. Dosage can be adjusted at no fewer than two-day intervals.

For the treatment of bipolar disorder, patients will usually be advised to take an initial dose of 40 mg to 80 mg twice per day. Medication should be adjusted on the second day of treatment from 60 mg to 80 mg twice per day. 

Capsules should not be opened or chewed, but swallowed whole and during high-caloric meals to ensure good absorption[2].

Intramuscular injection: Administering ziprasidone via injection is used to quickly treat severe agitation or aggression in patients with bipolar disorder or schizophrenia, or to treat aggression derived from substance intoxication or other natural causes[3].

  • It is recommended to administer 10 mg to 20 mg with a maximum dose of 40 mg per day.
  • It should not be administered intravenously, only muscularly[4].

How long does ziprasidone stay in your system?

Ziprasidone stays in your system for 7-10 hours and is then eliminated via hepatic metabolism, through the liver[5].

Ziprasidone side effects

Ziprasidone can cause multiple adverse effects. Common side effects include[1]:

  • dizziness, drowsiness, light-headedness
  • headache
  • nausea, vomiting
  • hyperglycemia (increase in blood sugar) 

Serious side effects are the following. If you notice any of these symptoms, you should stop taking ziprasidone and see your doctor immediately:

  • fluttering in your chest, irregular heartbeat, or pounding
  • dizziness
  • difficulty breathing
  • fever
  • muscle stiffness
  • confusion or agitation
  • sores on the skin or in the mouth
  • cough
  • increased thirst and urination and a dry mouth
  • heavy sweating

Patients are also at risk of neuroleptic malignant syndrome[6]. If you have stiff muscles, high fever, high or low blood pressure, difficulty in breathing, or heavy sweating, see a doctor immediately.

Stop taking the medicine and seek medical advice if you notice symptoms of an allergy or reaction after starting the medicine, such as hives, difficulty breathing, swelling, allergic skin reactions, rash, eye and throat irritation, or fever. These may be symptoms of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), which is extremely rare but has been related to ziprasidone exposure[1].

Treatment with ziprasidone may also lead to tardive dyskinesia, a condition characterized by repetitive, involuntary facial muscle movements. If dyskinesia is suspected, stop taking the medication and see your doctor immediately[7].

Finally, antipsychotic drugs can cause motor and sensory instability, leading to falls and accidents, which may result in fractures or other injuries. 

This is not a complete list of ziprasidone side effects. If in doubt, consult your doctor.

Ziprasidone precautions

Before taking ziprasidone, thoroughly inform your doctor of any pre-existing medical conditions and on your own and your family’s medical history, especially related to heart disease, diabetes, low white blood cell count, dementia, obesity, sleep apnea, difficulty swallowing, low levels of potassium or magnesium, or seizures.

It is important to discuss any risks and benefits of treatment with your medical professional before you begin taking ziprasidone or other antipsychotic medication.

Precautions should be taken regarding the following situations:

Patients with diabetes mellitus or with a family history of diabetes: Patients should be monitored daily when taking ziprasidone, and should do so with caution[8].

Patients over 65 years old that suffer from dementia-related psychosis: Patients should not be treated with Ziprasidone, as it is associated with cognitive decline, an increased risk of stroke, and an increased risk of death[1].

Patients with heart problems or with a family history of heart disease: Patients should inform their doctor if they or people in their family have a history of heart rhythm problems, slow heartbeat, heart disease, cardiac death, or heart attacks; Ziprasidone causes QT prolongation, a condition that affects the heart’s rhythm, leading to irregular heartbeat, fainting, dizziness, and other very severe afflictions. Even if you have no heart disease history, let your doctor know if you are taking any other medication, as this can increase your risk of QT prolongation[9].

Patients with low white blood cells: Patients should inform their doctor and monitor their blood count during the first two months of treatment with ziprasidone, as its intake causes the risk of leukopenia, neutropenia, and agranulocytosis. 

Ziprasidone may also cause dizziness or drowsiness so make sure you know how you react to the drug before you drive or operate heavy machinery. 

If you are pregnant or suspect pregnancy, please inform your doctor, as alternative medication with a better safety profile is preferred[10].

If you are currently breastfeeding, please take ziprasidone with caution, as infants exposed to the drug via breastfeeding may suffer from a number of side-effects, such as poor feeding, excess sedation, or abnormal muscle movements[11].

Treatment with ziprasidone is long term; therefore, do not stop taking it even though you feel well, as interrupting the treatment or skipping doses may risk a relapse in symptoms. Take ziprasidone as ordered by your doctor to ensure it works properly.

Ziprasidone interactions

Ziprasidone should not be taken with any other drug that prolongs the QT interval[12]. Do not take ziprasidone if you are taking any of the following medications, as they may cause severe adverse reactions.

  • Amiodarone (Cordarone)
  • Arsenic trioxide (Trisenox)
  • Chlorpromazine (Thorazine)
  • Disopyramide (Norpace)
  • Dofetilide (Tikosyn)
  • Dolasetron mesylate (Anzemet)
  • Droperidol (Inapsine)
  • Gatifloxacin (Tequin)
  • Halofantrine
  • Levomethadyl acetate,
  • Mefloquine (Lariam)
  • Mesoridazine (Serentil)
  • Moxifloxacin (Avelox)
  • Pentamidine (Nebupent)
  • Pimozide (Orap)
  • Probucol
  • Procainamide (Pronestyl)
  • Quinidine (Cardioquin)
  • Sotalol (Betapase)
  • Sparfloxacin (Zagam)
  • Tacrolimus (Prograf)
  • Thioridazine (Mellaril)

This is not an exhaustive list; please consult your healthcare provider to discuss further. 

Patients taking medication that acts on the central nervous system should also not use ziprasidone, as there is the potential of additive adverse reaction.

Remember to always inform your doctor of any other medication you might be taking, including non-prescription medication, herbal or alternative medicine, nutritional supplements, and vitamins. Make sure to inform your healthcare provider if you are using antidepressants, anxiety medication, carbamazepine, diuretics, dopamine agonists, ketoconazole, medication for high blood pressure, mental illness, seizures, or anxiety, sedatives, sleeping pills, or tranquillisers. 

Finally, avoid consuming alcohol while using ziprasidone.

Ziprasidone storage

Ziprasidone should not be exposed to heat, light, or humidity, and should be stored in its original container at room temperature, provided it does not exceed 30°C (86 F) and is kept out of the reach of children.

Ask your pharmacist for proper disposal of leftover or expired medication, avoiding risks to public health and the environment.

What to do if you overdose on ziprasidone

If you overdose on ziprasidone, seek immediate medical care. If the patient presents symptoms of overdose such as collapse, seizures, or trouble breathing, call your emergency services immediately.

There is no specific treatment to reverse the effects of a ziprasidone overdose.

FAQs

How long does it take for ziprasidone to work?

Ziprasidone should always be taken with food, as its absorption is increased twofold. After administration, it reaches peak plasma concentrations in 6-8 hours.

Who makes ziprasidone?

Ziprasidone is produced by Pfizer under the brand name Geodon.

What do I do if I miss a dose?

If you miss a dose, take it as soon as possible. However, if it is near the time for the next dose, skip the missed dose. Do not double the dose.

What supplements interact with ziprasidone?

Using melatonin whilst being treated with ziprasidone might increase side effects, such as difficulty concentrating, dizziness or drowsiness. It might also affect judgement, thinking, and motor coordination, especially in elderly patients.

Resources:

  1. Younce JR, Davis AA, Black KJ. A systematic review and case series of Ziprasidone for psychosis in Parkinson's Disease. J Parkinsons Dis. 2019; 9(1):63-71. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398550/
  2. Gandelman K, Alderman JA, Glue P, Lombardo I, LaBadie RR, Versavel M, Preskorn SH. The impact of calories and fat content of meals on oral Ziprasidone absorption: A randomised, open-label, crossover trial. J Clin Psychiatry. 2009 Jan; 70(1):58-62. https://pubmed.ncbi.nlm.nih.gov/19026256/
  3. Shim IH, Bahk WM, Woo YS, Yoon BH. Pharmacological treatment of major depressive episodes with mixed features: A systematic review. Clin Psychopharmacol Neurosci. 2018 Nov 30; 16(4):376-382. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245291/
  4. Su L, Lu Z, Shi S, Xu Y. Ziprasidone, haloperidol and clonazepam intramuscular administration in the treatment of agitation symptoms in Chinese patients with schizophrenia: A network meta-analysis. Gen Psychiatr. 2018; 31(2):e000016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234964/
  5. Mauri MC, Paletta S, Di Pace C, Reggiori A, Cirnigliaro G, Valli I, Altamura AC. Clinical Pharmacokinetics of Atypical Antipsychotics: An Update. Clin Pharmacokinet. 2018 Dec;57(12):1493-1528. https://pubmed.ncbi.nlm.nih.gov/29915922/
  6. Sedhai YR, Atreya A, Phuyal P, Basnyat S, Pokhrel S. Case Report: Ziprasidone induced neuroleptic malignant syndrome. F1000Res. 2021; 10:124. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7953912/
  7. Macaluso M, Preskorn SH. Knowledge of the pharmacology of antidepressants and antipsychotics yields results comparable with pharmacogenetic testing. J Psychiatr Pract. 2018 Nov; 24(6):416-419. https://pubmed.ncbi.nlm.nih.gov/30395549/
  8. Scheen AJ, De Hert M. [Drug-induced diabetes mellitus: the example of atypical antipsychotics]. Rev Med Liege. 2005 May-Jun; 60(5-6):455-60. https://pubmed.ncbi.nlm.nih.gov/16035311/
  9. Aronow WS, Shamliyan TA. Effects of atypical antipsychotic drugs on QT interval in patients with mental disorders. Ann Transl Med. 2018 Apr; 6(8):147. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952011/
  10. Grunze H, Vieta E, Goodwin GM, Bowden C, Licht RW, Azorin JM, Yatham L, Mosolov S, Möller HJ, Kasper S., Members of the WFSBP task force on bipolar affective disorders working on this topic. The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder. World J Biol Psychiatry. 2018 Feb; 19(1):2-58. https://pubmed.ncbi.nlm.nih.gov/29098925/
  11. Larsen ER, Damkier P, Pedersen LH, Fenger-Gron J, Mikkelsen RL, Nielsen RE, Linde VJ, Knudsen HE, Skaarup L, Videbech P., Danish Psychiatric Society. Danish Society of Obstetrics and Gynecology. Danish Paediatric Society. Danish Society of Clinical Pharmacology. Use of psychotropic drugs during pregnancy and breast-feeding. Acta Psychiatr Scand Suppl. 2015;(445):1-28. https://pubmed.ncbi.nlm.nih.gov/26344706/
  12. Product Information. Geodon (Ziprasidone). Pfizer U.S. Pharmaceuticals Group (2001). https://labeling.pfizer.com/showlabeling.aspx?id=584