II. Indications
- Schizophrenia (including acute episodic Agitation)
- Mania
- Bipolar Disorder
- Tourette's Syndrome (not FDA approved)
III. Mechanism
- Primarily a Serotonin 2A Antagonist (Dopamine D2 Antagonist activity is much less)
IV. Class
- Atypical Antipsychotic (Second Generation agent)
V. Dosing: Schizophrenia
- Oral
- Start: 20 mg orally twice daily taken with meals (at least 500 kcal)
- Titrate dose as often as every 2-3 days to effective dose twice daily
- Maximum: 80 mg orally twice daily
-
Parenteral (acute Agitation)
- Ziprasidone 10 to 20 mg IM
- May repeat 10 mg every 2 hours (or 20 mg every 4 hours) up to cummulative maximum of 40 mg/day
- Maximum: 40 mg/day
VI. Dosing: Bipolar I Disorder, Mania or Mixed Disorder
- Start 40 mg orally twice daily taken with meals (at least 500 kcal)
- May increase to 60 to 80 mg orally twice daily after the first 1-2 days
- Target dose: 40 to 80 mg orally twice daily
- Maximum: 80 mg orally twice daily
VII. Advantages
- Minimal weight gain than with other Atypical Antipsychotics
- Lower risk of diabetes than with other Atypical Antipsychotics
VIII. Drug Interactions
- Must be taken with meals of at least 500 kcals to ensure adequate absorption
- Metabolized by CYP3A4
- Increase Antipsychotic levels (toxicity risk): Monitor for toxicity
- Decrease Antipsychotic levels (lower efficacy)
IX. Adverse Effects
- Lower Extrapyramidal Side Effects compared with other Antipsychotics
- Somnolence (esp. Overdose)
- Nausea
- Weakness
- May increase Serum Prolactin
- QTc Prolongation (more than with other Atypical Antipsychotics, but no increased mortality)
- DRESS Syndrome (rare)
X. Safety
- Pregnancy Category C
- Avoid in Lactation
XI. Monitoring
- See Antipsychotics
XII. Resources
XIII. References
- (2016) Med Lett Drugs Ther 58(1510): 160-5
- Glauser and Peters (2016) Crit Dec Emerg Med 30(4): 17-27
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 42-3
Images: Related links to external sites (from Bing)
Related Studies
| ziprasidone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| ZIPRASIDONE HCL 20 MG CAPSULE | Generic | $0.26 each |
| ZIPRASIDONE HCL 40 MG CAPSULE | Generic | $0.27 each |
| ZIPRASIDONE HCL 60 MG CAPSULE | Generic | $0.36 each |
| ZIPRASIDONE HCL 80 MG CAPSULE | Generic | $0.41 each |