Ziprasidone IM

GEODON IM

What it isIM D2 and 5-HT2A antagonist (GEODON IM, 2002) with broad receptor activity; acute agitation in schizophrenia.

Why this oneIM half-life 2–5 h (shorter than oral) makes it useful when a short-acting atypical is wanted.

What limits itQTc is the class concern (oral ziprasidone carries the largest atypical QTc effect); avoid stacking with other QT-prolongers.

FDA-approved for

BOXED WARNING Increased mortality in elderly patients with dementia-related psychosis

FDA dosing	Population	Start	Target	Max
Acute agitation in schizophrenia (intramuscular)	Adults	10–20 mg IM		40 mg/day

Renal IM: use with caution in renal impairment (cyclodextrin excipient cleared by renal filtration); oral: no adjustment needed

Hepatic Undefined for IM (not evaluated); hepatic impairment increases oral ziprasidone AUC

IM 10 mg may be given every 2 h; 20 mg every 4 h; max 40 mg/day

Intramuscular use only; do not administer intravenously
Reconstitute vial with 1.2 mL Sterile Water for Injection (20 mg/mL)
Replace IM with oral ziprasidone as soon as possible; IM not studied beyond 3 consecutive days

Known history of QT prolongation (including congenital long QT syndrome)
Recent acute myocardial infarction
Uncompensated heart failure
Concomitant use with other drugs that have demonstrated QT prolongation
Concomitant use of monoamine oxidase inhibitors (MAOIs), or use within 14 days of stopping MAOIs (including linezolid and intravenous methylene blue)

Pregnancy Third-trimester exposure risks neonatal extrapyramidal/withdrawal symptoms

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

⚠ BOXED WARNING

Direct muscarinic antagonism0 / 4