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ziprasidone
generic
Black Box Warnings .
Dementia-Related Psychosis
not approved for dementia-related psychosis; incr. mortality risk in elderly pts on antipsychotic tx for dementia-related psychosis; most deaths due to cardiovascular or infectious events
Adult Dosing .
Dosage forms: CAP: 20 mg, 40 mg, 60 mg, 80 mg; INJ: 20 mg per mL
schizophrenia
- [20 mg PO bid]
- Start: 20 mg PO bid; Max: 160 mg/day; Info: may adjust dose q2 days prn; doses >40 mg/day rarely more effective; periodically reassess need for tx; give w/ food; do not open cap; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
bipolar I disorder, manic/mixed
- [monotherapy]
- Dose: 40-80 mg PO bid; Start: 40 mg PO bid x1 day, then 60-80 mg PO bid; Max: 160 mg/day; Info: for acute tx; may adjust dose q2 days prn; give w/ food; do not open cap; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
- [valproate or lithium adjunct]
- Dose: 40-80 mg PO bid; Info: for maintenance tx; continue tx at same dose at which pt initially stabilized; periodically reassess need for tx; give w/ food; do not open cap; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
agitation, schizophrenia-associated
- [10 mg IM q2h prn]
- Alt: 20 mg IM q4h prn; Max: 40 mg/day x3 days; Info: switch to PO ASAP; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
renal dosing
- [PO route]
- renal impairment: no adjustment
- HD: no adjustment; no supplement; PD: not defined
- [IM route]
- renal impairment: not defined, caution advised; Info: risk of IM vehicle accumulation
- HD/PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: CAP: 20 mg, 40 mg, 60 mg, 80 mg
bipolar I disorder, manic/mixed (off-label)
- [10-17 yo, <45 kg]
- Dose: 30-40 mg PO bid; Start: 20 mg PO qpm x1 day, then incr. by 20 mg/day PO q2 days; Max: 160 mg/day; Info: give w/ food; do not open cap; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
- [10-17 yo, >45 kg]
- Dose: 40-80 mg PO bid; Start: 20 mg PO qpm x1 day, then incr. by 20 mg/day PO q2 days; Max: 160 mg/day; Info: give w/ food; do not open cap; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
Tourette syndrome (off-label)
- [7-16 yo]
- Dose: 20 mg PO bid; Start: 5 mg PO qd x3 days, then incr. to 5 mg PO bid and titrate as tolerated; Max: 40 mg/day; Info: give w/ food; do not open cap; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [not defined]
- hepatic impairment: consider adult hepatic dosing for guidance
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- MAO inhibitor use w/in 14 days
- long QT syndrome, congenital
- QT prolongation
- QT prolongation hx
- ventricular arrhythmia
- ventricular arrhythmia hx
- bradycardia
- MI, recent
- heart failure, decompensated
- electrolyte abnormalities, uncorrected
- hypokalemia
- hypomagnesemia
- caution: QT prolongation family hx
- caution: elderly pts
- caution: hepatic impairment
- caution: renal impairment (IM use)
- caution: psychosis, dementia-associated
- caution: neuroleptic malignant syndrome hx
- caution: seizure disorder
- caution: seizure hx
- caution: cardiac dz
- caution: cerebrovascular dz
- caution: hypotension
- caution: hypovolemia
- caution: dehydration
- caution: environmental temperature, high
- caution: aspiration pneumonia risk
- caution: diabetes mellitus
- caution: diabetes mellitus risk
- caution: leukopenia
- caution: leukopenia hx, drug-induced
- caution: neutropenia
- caution: neutropenia hx, drug-induced
Drug Interactions .
Overview
ziprasidone
atypical antipsychotic
- CNS depression
- decreases central histamine effects
- dopamine antagonist
- extrapyramidal effects
- hyperglycemic effects
- hyperprolactinemic effects
- hyperthermia
- hypotensive effects
- lowers seizure threshold
- prolongs QT interval (known)
- serotonergic effects
- add MAO inhibitor to Interaction Check if recent (14 days) use
Contraindicated
- amiodarone
- arsenic trioxide
- bedaquiline
- chlorpromazine
- cisapride
- disopyramide
- dofetilide
- domperidone
- dronedarone
- droperidol
- ibutilide
- isocarboxazid
- levoketoconazole
- linezolid
- loperamide
- mefloquine
- methadone
- methylene blue injection
- moxifloxacin
- nilotinib
- panobinostat
- pentamidine
- phenelzine
- pimozide
- procainamide
- quinidine (antiarrhythmic)
- selegiline transdermal
- sotalol
- tacrolimus
- thioridazine
- toremifene
- tranylcypromine
- vandetanib
Avoid/Use Alternative
- 5-HTP
- adagrasib
- albuterol
- albuterol inhaled
- aldesleukin
- alfentanil
- alfuzosin
- almotriptan
- amifampridine
- amisulpride
- amitriptyline
- amoxapine
- amphetamine
- anagrelide
- apalutamide
- apomorphine
- arformoterol inhaled
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- artemether/lumefantrine
- asciminib
- asenapine
- azithromycin
- benztropine
- berotralstat
- brexpiprazole
- bromocriptine
- buprenorphine
- buspirone
- butalbital
- butorphanol
- cabergoline
- cabozantinib
- carbamazepine
- cariprazine
- ceritinib
- chloroquine
- ciprofloxacin
- citalopram
- clarithromycin
- clofazimine
- clomipramine
- clonidine
- clozapine
- cocaine
- codeine
- crizotinib
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- dasatinib
- degarelix
- desflurane
- desipramine
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- deutetrabenazine
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- dexmedetomidine injection
- dexmethylphenidate
- dextroamphetamine
- dextromethorphan
- dihydrocodeine
- dihydroergotamine
- donepezil
- doxepin
- doxepin topical
- doxylamine
- duloxetine
- efavirenz
- eletriptan
- eliglustat
- encorafenib
- entrectinib
- ephedra
- epirubicin
- ergotamine
- eribulin
- erythromycin
- escitalopram
- ethanol
- etrasimod
- fenfluramine
- fentanyl
- fexinidazole
- fingolimod
- flecainide
- fluconazole
- fluorouracil
- fluoxetine
- fluvoxamine
- formoterol inhaled
- foscarnet
- fostemsavir
- frovatriptan
- gemtuzumab ozogamicin
- gepirone
- gepotidacin
- gilteritinib
- givinostat
- glasdegib
- goserelin
- granisetron
- grapefruit
- haloperidol
- histrelin
- hydrocodone
- hydromorphone
- hydroxychloroquine
- hydroxyzine
- iloperidone
- imipramine
- inotuzumab ozogamicin
- isoflurane
- isoniazid
- ivabradine
- ivosidenib
- kava
- kratom
- lapatinib
- lasmiditan
- lefamulin
- lenvatinib
- leuprolide
- levalbuterol inhaled
- levofloxacin
- levomilnacipran
- levorphanol
- lisdexamfetamine
- lithium
- lofexidine
- lonafarnib
- lopinavir/ritonavir
- lumateperone
- lurasidone
- macimorelin
- mavorixafor
- meperidine
- metaxalone
- methamphetamine
- methylene blue oral
- methylergonovine
- methylphenidate
- metoclopramide
- metronidazole
- midazolam
- midostaurin
- mifepristone
- milnacipran
- mirtazapine
- mobocertinib
- morphine
- nalbuphine
- naratriptan
- nefazodone
- nortriptyline
- ofloxacin
- olanzapine
- oliceridine
- olodaterol inhaled
- ondansetron
- opium
- osilodrostat
- osimertinib
- oxaliplatin
- oxybate
- oxycodone
- oxymorphone
- ozanimod
- pacritinib
- paliperidone
- palonosetron
- paroxetine
- pasireotide
- pazopanib
- pentazocine
- phenobarbital
- pimavanserin
- pitolisant
- ponesimod
- posaconazole
- pralsetinib
- primaquine
- procarbazine
- promethazine
- propafenone
- protriptyline
- quetiapine
- quinidine (CYP2D6 inhibitor)
- quinine
- quizartinib
- ranolazine
- rasagiline
- relugolix
- remifentanil
- revumenib
- ribociclib
- rilpivirine
- risperidone
- rizatriptan
- romidepsin
- ropeginterferon alfa-2b
- rucaparib
- sacituzumab govitecan
- safinamide
- salmeterol inhaled
- SAMe
- selegiline
- selpercatinib
- sertraline
- sevoflurane
- siponimod
- solifenacin
- sorafenib
- St. John's wort
- sufentanil
- sumatriptan
- sunitinib
- tapentadol
- tazemetostat
- telavancin
- terbutaline
- tetrabenazine
- thalidomide
- tolterodine
- tramadol
- trazodone
- triclabendazole
- trifluridine
- trimethobenzamide
- trimipramine
- triptorelin
- valbenazine
- vardenafil
- vemurafenib
- venlafaxine
- vilanterol inhaled
- vilazodone
- voclosporin
- voriconazole
- vortioxetine
- yohimbe
- ziprasidone
- zolmitriptan
- zuranolone
Monitor/Modify Tx
- acarbose
- acebutolol
- aliskiren
- alogliptin
- alprazolam
- amantadine
- amifostine
- amiloride
- amlodipine
- apraclonidine ophthalmic
- aprocitentan
- articaine
- atenolol
- avanafil
- azilsartan medoxomil
- baclofen intrathecal
- benazepril
- berberine
- betaxolol
- betaxolol ophthalmic
- bethanechol
- bexagliflozin
- bisoprolol
- bortezomib
- brimonidine ophthalmic
- brimonidine topical
- bumetanide
- bupivacaine
- bupivacaine liposomal
- bupropion
- canagliflozin
- candesartan cilexetil
- cannabis
- captopril
- carteolol ophthalmic
- carvedilol
- chlordiazepoxide
- chloroprocaine
- chlorothiazide
- chlorthalidone
- cilostazol
- clevidipine
- clobazam
- clofarabine
- clonazepam
- clorazepate
- coenzyme Q-10
- colesevelam
- dapagliflozin
- daridorexant
- denileukin diftitox
- diazepam
- diltiazem
- dinutuximab
- dipyridamole
- doxazosin
- dronabinol
- dulaglutide
- empagliflozin
- enalapril
- enalaprilat
- entacapone
- eplerenone
- epoprostenol
- ertugliflozin
- esketamine
- esmolol
- estazolam
- eszopiclone
- ethacrynic acid
- ethanol (in some formulations)
- etomidate
- exenatide
- felodipine
- fenoldopam
- ferumoxytol
- flaxseed
- flibanserin
- fluphenazine
- flurazepam
- fosinopril
- foslevodopa
- furosemide
- gabapentin
- gabapentin enacarbil
- garlic
- glimepiride
- glipizide
- glyburide
- guanfacine
- hydralazine
- hydrochlorothiazide
- ifosfamide
- iloprost
- iloprost inhaled
- indapamide
- insulin
- iohexol
- iopamidol
- irbesartan
- iron sucrose
- isosorbide dinitrate
- isosorbide mononitrate
- isradipine
- ketamine
- labetalol
- landiolol
- lemborexant
- levobunolol ophthalmic
- levodopa
- lidocaine
- linagliptin
- liraglutide
- lisinopril
- lorazepam
- losartan
- loxapine
- lubiprostone
- magnesium sulfate
- maraviroc
- mepivacaine
- metformin
- methohexital
- methyldopa
- metolazone
- metoprolol
- miglitol
- milrinone
- minoxidil
- moexipril
- molindone
- nadolol
- nateglinide
- nattokinase
- naxitamab
- nebivolol
- nelarabine
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nimodipine
- nisoldipine
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- olmesartan medoxomil
- opicapone
- oxazepam
- oxybutynin
- palopegteriparatide
- pentobarbital
- perindopril
- perphenazine
- phenoxybenzamine
- phentolamine
- pindolol
- pioglitazone
- pramipexole
- pramlintide
- prazosin
- pregabalin
- primidone
- prochlorperazine
- propofol
- propranolol
- quazepam
- quinapril
- ramipril
- remimazolam
- repaglinide
- riociguat
- ropinirole
- ropivacaine
- rosiglitazone
- rotigotine transdermal
- sacubitril
- saxagliptin
- semaglutide
- sildenafil
- silodosin
- sitagliptin
- sodium ferric gluconate complex
- sotagliflozin
- sparsentan
- spironolactone
- suvorexant
- tadalafil
- tagraxofusp
- tamsulosin
- taurine
- telmisartan
- temazepam
- terazosin
- thiothixene
- timolol
- timolol ophthalmic
- tirzepatide
- tizanidine
- tolcapone
- torsemide
- trandolapril
- treprostinil
- triamterene
- triazolam
- trifluoperazine
- valsartan
- verapamil
- vosoritide
- zaleplon
- ziconotide
- zolpidem
Caution Advised
- acetazolamide
- aclidinium inhaled
- allopurinol
- atropine
- baclofen
- belladonna alkaloids
- botulinum toxin
- brivaracetam
- brompheniramine
- busulfan
- cannabidiol
- carbinoxamine
- carisoprodol
- cenobamate
- cetirizine
- chamomile, German
- chasteberry
- chlophedianol
- chlorambucil
- chlorpheniramine
- chlorzoxazone
- clemastine
- clidinium
- cyproheptadine
- dantrolene
- darifenacin
- dexbrompheniramine
- dexchlorpheniramine
- dichlorphenamide
- dicyclomine
- difelikefalin
- difenoxin
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fesoterodine
- flavoxate
- fosphenytoin
- galantamine
- ganaxolone
- glofitamab
- glycopyrrolate
- glycopyrrolate inhaled
- glycopyrronium topical
- homatropine
- hyoscyamine
- ipratropium inhaled
- lacosamide
- lamotrigine
- levetiracetam
- levocetirizine
- lindane topical
- magnesium citrate
- meclizine
- melatonin
- meprobamate
- methocarbamol
- methscopolamine
- methsuximide
- metyrapone
- metyrosine
- mitotane
- mosunetuzumab
- mycophenolate mofetil
- naltrexone
- orphenadrine
- oxcarbazepine
- passion flower
- perampanel
- pheniramine
- phenytoin
- polyethylene glycol
- polyethylene glycol/electrolytes
- pyrilamine
- ramelteon
- repotrectinib
- revefenacin inhaled
- rivastigmine
- rufinamide
- scopolamine
- selinexor
- sodium picosulfate
- sofpironium topical
- solriamfetol
- stiripentol
- sulfate bowel prep
- tasimelteon
- thiotepa
- tiagabine
- tiotropium inhaled
- topiramate
- treosulfan
- trihexyphenidyl
- triprolidine
- trospium
- umeclidinium inhaled
- valerian
- valproic acid
- vigabatrin
- viloxazine
- zonisamide
Adverse Reactions .
Serious Reactions
- neuroleptic malignant syndrome
- extrapyramidal sx, severe
- tardive dyskinesia
- dystonia
- QT prolongation
- torsades de pointes
- seizures
- syncope
- stroke
- priapism
- HTN, severe
- hyperglycemia
- diabetes mellitus
- serotonin syndrome
- hyperthermia
- hypersensitivity rxn
- drug rxn w/ eosinophilia and systemic sx
- Stevens-Johnson syndrome
- dysphagia, severe
- leukopenia
- neutropenia
- agranulocytosis
Common Reactions
- dyslipidemia
- extrapyramidal sx
- somnolence
- headache
- dizziness
- nausea
- akathisia
- constipation
- injection site pain (IM use)
- dyspepsia
- respiratory infection
- asthenia
- visual disturbance
- anxiety
- diarrhea
- vomiting
- xerostomia
- rash
- sialorrhea
- weight gain
- edema
- HTN
- pain
- anorexia
- diaphoresis (IM use)
- dysphagia
- fungal dermatitis
- hypesthesia
- menstrual irregularities
- speech disturbance
- tachycardia
- hypotension, orthostatic
- hyperprolactinemia
- photosensitivity
- impaired body temperature regulation
Safety/Monitoring .
Monitoring Parameters
fasting glucose at baseline if diabetes risk factors, then periodically; CBC w/ diff frequently during initial tx if pre-existing or hx of leukopenia/neutropenia; K and Mg at baseline if risk of disturbance, then if diuretic added cont. periodically; ECG at baseline if cardiac risk factors, then periodically; weight
Look/Sound-Alike Drug Names
ziprasidone confused with: zafirlukast; zidovudine; zonisamide; ZyPREXA
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, esp. in 3rd trimester; risk of teratogenicity not expected based on human data, though risk of neonatal extrapyramidal and withdrawal sx based on human data w/ antipsychotics
Pregnancy Registry
encourage pts to enroll in National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or www.womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; inadequate human data available, though no known risk of infant harm based on limited human data w/ other atypical antipsychotics; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver; CYP450: 3A4 substrate; Info: aldehyde oxidase substrate
Excretion: urine 20% (<1% unchanged), feces 66%; Half-life: 7h
Subclass: Antipsychotics, 2nd generation ; Bipolar Disorder ; Tic Disorders/Tourette Syndrome
Mechanism of Action
exact mechanism of action unknown; antagonizes dopamine D2 receptors, serotonin 5-HT2A receptors, others
Formulary .
No Formulary Selected
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