II. Indications

  1. Schizophrenia (including acute episodic agitation)
  2. Mania
  3. Bipolar Disorder
  4. Tourette's Syndrome (not FDA approved)

III. Mechanism

  1. Primarily a Serotonin 2A antagonist (Dopamine antagonist activity is much less)

IV. Class

  1. Atypical Antipsychotic (Second Generation agent)

V. Dosing

  1. Oral
    1. Ziprasidone 20 to 80 mg orally twice daily
  2. Parenteral
    1. Ziprasidone 10 to 20 mg IM

VI. Advantages

  1. Minimal weight gain than with other Atypical Antipsychotics
  2. Lower risk of diabetes than with other Atypical Antipsychotics

VII. Drug Interactions

  1. Increase Antipsychotic levels (toxicity risk): Monitor for toxicity
    1. Clarithromycin
    2. Erythromycin
    3. Grapefruit juice
    4. Fluconazole
    5. Itraconazole
    6. Ketoconazole
  2. Decrease Antipsychotic levels (lower efficacy)
    1. Carbamazepine
    2. Phenytoin

VIII. Adverse Effects

  1. Lower Extrapyramidal Side Effects compared with other Antipsychotics
  2. Somnolence (esp. Overdose)
  3. Nausea
  4. Weakness
  5. QTc Prolongation (more than with other Atypical Antipsychotics)

IX. Monitoring

X. References

  1. Glauser and Peters (2016) Crit Dec Emerg Med 30(4): 17-27

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Cost: Medications

ziprasidone (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
ZIPRASIDONE HCL 20 MG CAPSULE Generic $0.61 each
ZIPRASIDONE HCL 40 MG CAPSULE Generic $0.59 each
ZIPRASIDONE HCL 60 MG CAPSULE Generic $0.67 each
ZIPRASIDONE HCL 80 MG CAPSULE Generic $0.68 each
geodon (on 6/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
GEODON 20 MG CAPSULE Generic $0.61 each
GEODON 40 MG CAPSULE Generic $0.59 each
GEODON 60 MG CAPSULE Generic $0.67 each
GEODON 80 MG CAPSULE Generic $0.68 each