Classifications: psychotherapeutic; antipsychotic, atypical; Therapeutic: antipsychotic, atypical
Pregnancy Category: C
20 mg, 40 mg, 60 mg, 80 mg capsules; 20 mg/mL injection; 10 mg/mL suspension
Exerts antischizophrenic effects through dopamine (D2) and serotonin (5-HT2A) receptor antagonist. Exerts antidepressant effects through 5-HT1A agonism, 5-HT1D antagonism, and serotonin/norepinephrine reuptake inhibition.
Improves symptoms of schizophrenia, schizoaffective disorder, and psychotic depression.
Treatment of schizophrenia, acute bipolar mania.
Hypersensitivity to ziprasidone; history of QT prolongation including congenital long QT syndrome or with other drugs known
to prolong the QT interval; AV block, bundle branch block, cardiac arrhythmias, congenital heart disease, recent MI or uncompensated
heart failure; bradycardia, hypokalemia or hypomagnesemia; intravenous administration; neuroleptic malignant syndrome and
tardive dyskinesia; dehydration or hypovolemia; UV exposure and tanning beds; pregnancy (category C), lactation. Safety
and efficacy in children or adolescents are not established.
History of seizures, CVA, dementia, Parkinson's disease, or Alzheimer disease; known cardiovascular disease, conduction abnormalities,
treatment with antihypertensive drugs; cerebrovascular disease; hepatic impairment; seizure disorder, seizures; breast cancer;
risk factors for elevated core body temperature; esophageal motility disorders and risk of aspiration pneumonia; schizophrenia;
suicide potential; children >7 y for use in Tourette's syndrome only.
Route & Dosage
Adult: PO Start with 20 mg b.i.d. with food, may increase q2d up to 80 mg b.i.d. if needed IM 10 mg q2h or 20 mg q4h up to max of 40 mg/d
Adult: PO Start with 40 mg b.i.d. with food; may increase q2d up to 80 mg b.i.d. if needed
Note: CONTRAINDICATIONS for this drug. Do NOT administer to anyone with a history of cardiac arrhythmias or other cardiac disease,
hypokalemia, hypomagnesemia, prolonged QT/QTc interval, or to anyone on other drugs known to prolong the QTc interval. Withhold drug and consult physician if any of the foregoing conditions are present.
- Give with food.
- Make dosage adjustments at intervals of ≥2 d.
- Give deep IM into a large muscle.
- Store at 15°30° C (59°86° F).
Adverse Effects (≥1%) Body as a Whole:
Asthenia, myalgia, weight gain, flu-like syndrome
, face edema, chills, hypothermia. CNS: Somnolence,
akathisia, dizziness, extrapyramidal effects, dystonia, hypertonia, agitation, tremor, dyskinesias, hostility, paresthesia
confusion, vertigo, hypokinesia, hyperkinesias, abnormal gait, oculogyric crisis, hypesthesia, ataxia, amnesia, cogwheel
rigidity, delirium, hypotonia, akinesia, dysarthria, withdrawal syndrome
, buccoglossal syndrome
, choreoathetosis, diplopia
Tachycardia, postural hypotension, prolonged QTc
interval, hypertension. GI: Nausea, constipation
, dyspepsia, diarrhea
, dry mouth, anorexia, abdominal pain, vomiting. Metabolic:
Rhinitis, increased cough, dyspnea
Rash, fungal dermatitis, photosensitivity. Special Senses:
may decrease ziprasidone
may increase ziprasidone
levels; may enhance hypotensive effects of antihypertensive agents
; may antagonize effects of levodopa;
increased risk of arrhythmias and heart block due to prolonged QTc
interval with antiarrhythmic agents
, amoxapine, arsenic trioxide, chlorpromazine, clarithromycin, daunorubicin, diltiazem, dolasetron, doxorubicin, droperidol, erythromycin, halofantrine, indapamide, levomethadyl, local anesthetics
, maprotiline, mefloquine, mesoridazine, octreotide, pentamidine, pimozide, probucol, gatifloxacin, grepafloxacin, levofloxacin, moxifloxacin, sparfloxacin, tricyclic antidepressants
, tacrolimus, thioridazine, troleandomycin;
additive CNS depression
, ethanol, opiate agonists
Well absorbed with 60% reaching systemic circulation. Peak:
68 h. Metabolism:
Extensively in the liver. Elimination:
20% of metabolites in urine, 66% of metabolites in bile. Half-Life:
Assessment & Drug Effects
- Lab tests: Baseline and periodic ECG, serum potassium and serum magnesium, especially with concomitant diuretic therapy.
Periodically monitor blood glucose.
- Monitor diabetics for loss of glycemic control.
- Monitor for S&S of torsade de pointes (e.g., dizziness, palpitations, syncope), tardive dyskinesia (see Appendix F) especially
in older adult women and with prolonged therapy, and the appearance of an unexplained rash. Withhold drug and report to
physician immediately if any of these develop.
- Monitor for signs and symptoms of suicidality.
- Monitor I&O ratio and pattern: Notify physician if diarrhea, vomiting or any other conditions develops which may cause electrolyte
- Monitor BP lying, sitting, and standing. Report orthostatic hypotension to physician.
- Monitor cognitive status and take appropriate precautions.
- Monitor for loss of seizure control, especially with a history of seizures or dementia.
Patient & Family Education
- Carefully monitor blood glucose levels if diabetic.
- Be aware that therapeutic effect may not be evident for several weeks.
- Report any of the following to a health care provider immediately: Palpitations, faintness or loss of consciousness, rash,
abnormal muscle movements, vomiting or diarrhea.
- Do not drive or engage in potentially hazardous activities until response to drug is known.
- Make position changes slowly and in stages to prevent dizziness upon arising.
- Avoid strenuous exercise, exposure to extreme heat, or other activities that may cause dehydration.