Ziprasidone

FDA label

Read the full label on DailyMed ↗

Titration Adjust at intervals of ≥2 days (schizophrenia)

Renal Oral: no adjustment needed. IM: use caution — cyclodextrin excipient renally cleared

Hepatic Undefined

Instructions

• Take capsules with food; swallow whole — do not open, crush, or chew
• IM for agitation ≤3 consecutive days; switch to oral as soon as possible
• MAOI switch: ≥14 days after stopping an MAOI before starting; ≥3 days after stopping ziprasidone before an MAOI

Contraindications

• Known QT prolongation (incl. congenital long QT), recent acute MI, or uncompensated heart failure
• Concomitant use of other QT-prolonging drugs
• MAOIs (concurrently or within 14 days) due to risk of serotonin syndrome

Cautions

• QT prolongation and risk of sudden death; avoid with other QT-prolonging drugs and in electrolyte disturbance
• Serotonin syndrome (may occur even alone)
• Neuroleptic malignant syndrome
• Severe cutaneous reactions (DRESS, Stevens-Johnson)
• Tardive dyskinesia
• Metabolic changes: hyperglycemia, dyslipidemia, weight gain
• Orthostatic hypotension
• Leukopenia/neutropenia/agranulocytosis
• Seizures
• Cerebrovascular events and increased mortality in elderly with dementia-related psychosis

Adverse reactions

• Somnolence
• Respiratory tract infection
• Extrapyramidal symptoms
• Dizziness
• Akathisia
• Nausea
• Abnormal vision
• Asthenia
• Vomiting

Pregnancy Third-trimester exposure risks neonatal extrapyramidal/withdrawal symptoms; epidemiologic data show no clear risk of major birth defects.

Lactation Present in human milk; monitor infant for excess sedation, irritability, poor feeding, and extrapyramidal symptoms.