Ziprasidone (Geodon)

 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.
FDA INDICATIONS:
1) Schizophrenia
2) Acute agitation in schizophrenia
3) Acute mania/mixed mania
4) Bipolar maintenance

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
  • Metabolized by CYP3A4
    • CYP3A4 Inhibitors rarely lead to clinically significant increased plasma levels of ziprasidone
  • Highly protein bound
  • FDA a warning about QTc prolongation
    • Likely overly concerned
    • Does not cause dose dependent QTc prolongation
  • Intramuscular formulations (10mg-20mg) available
    • Don’y give IM 3 consecutive days in a row
  • Ziprasidone is an antagonist at 5HT2C, 5HT7, 5HT1B/D, and α2 receptors
  • Ziprasidone is a 5HT1A partial agonist
  • Ziprasidone is a weak NET and SERT inhibitor

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.

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