Ziprasidone (Geodon)

Contents

Clinical Information

 

HALF-LIFE: 6-7 hours

STARTING DOSE: 20mg-40mg PO BID

TARGET DOSING RANGE: 40mg-200mg daily (in divided doses)

BEST TIME TO DOSE: Any

HOW TO DOSE:

Schizophrenia: Initial 20mg-60mg PO BID

Bipolar disorder: Initial 40mg PO BID for 2 days then increase to 60mg PO BID or 80mg PO BID

PREGNANCY: Minimal data on safety.

BREASTFEEDING: Minimal data on safety.

Side Effects

  • Sedation, dizziness, dry mouth, nausea, upset stomach, elevated prolactin levels (menstrual irregularities, sexual dysfunction, breast tenderness, headaches, galactorrhea), orthostatic hypotension, movement disorders, seizures (rare), Neuroleptic Malignant Syndrome (Rare), Arrhythmias (FDA issued a warning about QTc prolongation), extrapyramidal symptoms (parkinsonism, dystonia), akathisia/restlessness

FDA Indications

  1. Schizophrenia
  2. Acute agitation in schizophrenia
  3. Acute mania/mixed mania
  4. Bipolar maintenance

Off Label Uses: Bipolar Disorder, Acute agitation

Mechanism(s) of Action

  • Dopamine 2 (D2) Receptor Antagonist

Additional Information

  • Little to no propensity for weight gain, dyslipidemia, or insulin resistance
  • Must be taken with food (500 calorie meal) – Absorption is approximately doubled if taken with food
  • Intramuscular formulations (10mg-20mg) available

References

  1. Cooper, J. R., Bloom, F. E., & Roth, R. H. (2003). The biochemical basis of neuropharmacology (8th ed.). New York, NY, US: Oxford University Press.
  2. Iversen, L. L., Iversen, S. D., Bloom, F. E., & Roth, R. H. (2009). Introduction to neuropsychopharmacology. Oxford: Oxford University Press.
  3. Puzantian, T., & Carlat, D. J. (2016). Medication fact book: for psychiatric practice. Newburyport, MA: Carlat Publishing, LLC.
  4. J. Ferrando, J. L. Levenson, & J. A. Owen (Eds.), Clinical manual of psychopharmacology in the medically ill(pp. 3-38). Arlington, VA, US: American Psychiatric Publishing, Inc.
  5. Schatzberg, A. F., & DeBattista, C. (2015). Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Publishing.
  6. Schatzberg, A. F., & Nemeroff, C. B. (2017). The American Psychiatric Association Publishing textbook of psychopharmacology. Arlington, VA: American Psychiatric Association Publishing.
  7. Stahl, S. M. (2014). Stahl’s essential psychopharmacology: Prescriber’s guide (5th ed.). New York, NY, US: Cambridge University Press.
  8. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY, US: Cambridge University Press.
  9. Whalen, K., Finkel, R., & Panavelil, T. A. (2015). Lippincotts illustrated reviews: pharmacology. Philadelphia, PA: Wolters Kluwer.