Ziprasidone
Generic: ziprasidone hydrochloride · Brand: Geodon® · Class: 2nd Gen Antipsychotic
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How It Works
Ziprasidone is a second-generation (atypical) antipsychotic that blocks dopamine and serotonin receptors. Like lurasidone, it is one of the most weight-neutral antipsychotics available and has minimal metabolic effects. However, it has a unique concern: it can prolong the QT interval (a measure of heart electrical activity), which requires baseline and periodic EKG monitoring. It must be taken with food to achieve adequate absorption. Available in oral and IM injectable formulations.
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What It Treats
SchizophreniaFDA-approved for adults
Bipolar I DisorderFDA-approved for acute manic and mixed episodes
Acute AgitationIM formulation available for rapid control of agitation in schizophrenia or bipolar
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Dosing Overview
| Population | Start | Typical Range | Max |
|---|---|---|---|
| Adults Schizophrenia | 20 mg twice daily | 40–80 mg twice daily | 200 mg/day |
| Adults Bipolar Mania | 40 mg twice daily | 40–80 mg twice daily | 160 mg/day |
| IM Acute Agitation | 10–20 mg | 10–20 mg | 40 mg/day |
MUST be taken with food (at least 500 calories) twice daily. Available as capsules and IM injection. An EKG before starting and periodically during treatment is recommended due to QT prolongation risk.
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Side Effects
Common
- Sedation
- Dizziness
- Nausea
- Constipation
- Rash
- Minimal weight gain
- QT prolongation
- Movement side effects
Call us if you notice
- Tardive dyskinesia (involuntary movements)
- Neuroleptic malignant syndrome (NMS)
- Significant weight gain or metabolic changes
- High blood sugar or new diabetes
- Severe restlessness (akathisia)
- Muscle stiffness or rigidity
- QT prolongation / cardiac arrhythmia
- Rash or allergic reaction
Ziprasidone is very weight-neutral but the QT prolongation risk requires cardiac monitoring. The food requirement is essential — taking without food can reduce absorption by up to 50%.
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Tips for Success
Same Time DailyTake at the same time each day for consistent levels in your system.
With FoodTaking with food reduces nausea and stomach upset.
Don't Stop AbruptlyAlways taper with your provider guidance — stopping suddenly can cause rebound symptoms.
Avoid AlcoholAlcohol increases sedation and side effects significantly.
Tell All ProvidersLet other prescribers know what you are taking — interactions matter.
Track Your MoodNote any changes in mood, movement, or weight and share with your provider.
EKG MonitoringAn EKG before starting and periodically during treatment helps monitor for cardiac effects.
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Important Safety Information
Tardive Dyskinesia: Long-term use of antipsychotics can cause involuntary repetitive movements of the face, tongue, or limbs. Report any unusual movements to your provider immediately.
Elderly Patients with Dementia: Antipsychotics carry a black box warning for increased risk of death in elderly patients with dementia-related psychosis. These medications are not approved for this use.
Metabolic Effects: Many antipsychotics can cause weight gain, elevated blood sugar, and increased cholesterol. Your provider will monitor these regularly.
Pregnancy & Breastfeeding: Discuss risks and benefits with your provider. Do not stop without consultation.
Drug Interactions: Antipsychotics interact with many medications including other CNS depressants, blood pressure medications, and QT-prolonging drugs. Always share your full medication list.
QT Prolongation: Ziprasidone prolongs the QT interval and should be avoided in patients with known cardiac arrhythmias or those taking other QT-prolonging medications. An EKG is recommended before starting treatment.
Questions? I am here.
Reach me between appointments if you have concerns about side effects, notice mood changes, or have questions about your medication.
360-389-3712
info@rootedmindspsychiatry.com