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ziprasidone

N05AE04

Forms & Strengths

Capsules: 20 mg, 40 mg, 60 mg, 80 mg
Intramuscular injection: 20 mg/mL

Adult Dosing

Schizophrenia: 20 mg twice daily with food, titrating up to 40-80 mg twice daily; maximum 160 mg/day
Acute Bipolar Mania: 40 mg twice daily on day 1, then 40-80 mg twice daily on subsequent days; maximum 80 mg twice daily
Acute Agitation (IM): 10 mg to 20 mg as a single dose; max 40 mg/day (10 mg every 2 hours or 20 mg every 4 hours)

Pediatric Dosing

Safety and efficacy in pediatric patients have not been established

Indications

Treatment of schizophrenia
Acute treatment of manic or mixed episodes associated with bipolar disorder (monotherapy)
Acute agitation in schizophrenia (intramuscular)

Mechanism of Action

Atypical antipsychotic agent
High affinity antagonism at dopamine D2 and serotonin 5-HT2A receptors
Moderate antagonism at serotonin 5-HT1D and 5-HT2C receptors
Moderate agonist activity at serotonin 5-HT1A receptors
Moderate inhibition of serotonin and norepinephrine reuptake

Contraindications

Known history of QT prolongation or congenital long QT syndrome
Recent acute myocardial infarction or uncompensated heart failure
Concurrent administration of other drugs that prolong the QT interval
Known hypersensitivity to ziprasidone

Adverse Reactions

Somnolence
Extrapyramidal symptoms
Dizziness
Nausea
Respiratory tract infection
QTc interval prolongation
Orthostatic hypotension
Weight gain
Neuroleptic malignant syndrome

Drug Interactions

Class IA and III antiarrhythmics (contraindicated due to additive QT prolongation)
CYP3A4 inhibitors (e.g., ketoconazole) may increase ziprasidone concentration
CYP3A4 inducers (e.g., carbamazepine) may decrease ziprasidone concentration
CNS depressants and alcohol (additive sedation and impairment)
Levodopa and dopamine agonists (pharmacodynamic antagonism)

Curated Content: Needs Vetting Before Put to Clinical Use