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 D2 Antagonist activity is much less)

IV. Class

  1. Atypical Antipsychotic (Second Generation agent)

V. Dosing: Schizophrenia

  1. Oral
    1. Start: 20 mg orally twice daily taken with meals (at least 500 kcal)
    2. Titrate dose as often as every 2-3 days to effective dose twice daily
    3. Maximum: 80 mg orally twice daily
  2. Parenteral (acute Agitation)
    1. Ziprasidone 10 to 20 mg IM
    2. May repeat 10 mg every 2 hours (or 20 mg every 4 hours) up to cummulative maximum of 40 mg/day
    3. Maximum: 40 mg/day

VI. Dosing: Bipolar I Disorder, Mania or Mixed Disorder

  1. Start 40 mg orally twice daily taken with meals (at least 500 kcal)
  2. May increase to 60 to 80 mg orally twice daily after the first 1-2 days
  3. Target dose: 40 to 80 mg orally twice daily
  4. Maximum: 80 mg orally twice daily

VII. Advantages

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

VIII. Drug Interactions

  1. Must be taken with meals of at least 500 kcals to ensure adequate absorption
  2. Metabolized by CYP3A4
  3. Increase Antipsychotic levels (toxicity risk): Monitor for toxicity
    1. Clarithromycin
    2. Erythromycin
    3. Grapefruit juice
    4. Fluconazole
    5. Itraconazole
    6. Ketoconazole
  4. Decrease Antipsychotic levels (lower efficacy)
    1. Carbamazepine
    2. Phenytoin

X. Safety

  1. Pregnancy Category C
  2. Avoid in Lactation

XI. Monitoring

XIII. References

  1. (2016) Med Lett Drugs Ther 58(1510): 160-5
  2. Glauser and Peters (2016) Crit Dec Emerg Med 30(4): 17-27
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  4. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 42-3

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Related Studies

Cost: Medications

ziprasidone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ZIPRASIDONE HCL 20 MG CAPSULE Generic $0.26 each
ZIPRASIDONE HCL 40 MG CAPSULE Generic $0.27 each
ZIPRASIDONE HCL 60 MG CAPSULE Generic $0.36 each
ZIPRASIDONE HCL 80 MG CAPSULE Generic $0.41 each