ziprasidone (Rx) - Geodon

 
 
 

Adult Dosing & Uses

Dosing Forms & Strengths

capsules

  • 20mg
  • 40mg
  • 60mg
  • 80mg

powder for injection

  • 20mg/mL

oral suspension

  • 10mg/mL

Schizophrenia

Initial: 20 mg BID with food, may increase q2d PRN; not to exceed 80 mg BID

Maintenance: Periodically assess need for maintenance; no added benefit shown in clinical trials with doses above 20 mg BID

Acute Agitation With Schizophrenia

IM: 10 mg IM q2hr, or 20 mg IM q4hr; not to exceed 40 mg qD for up to 3 days (switch to oral if continuing)

Bipolar I Disorder

Acute treatment of manic or mixed episodes

  • Initial: 40 mg PO BID PO with food
  • Titration: On day 2, may increase dose if needed to 60-80 mg PO BID
  • Adjust dose according to tolerance and efficacy within range of 40-80 mg BID

Maintenance

  • Indicated for maintenance therapy as an adjunct to lithium or valproate
  • Continue at same dose which patient was initially stabilized within range of 40-80 mg PO BID with food
  • Periodically reassess need for maintenance treatment
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Pediatric Dosing & Uses

Safety and efficacy not established

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Drug Interactions

Interaction Checker

ziprasidone and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Somnolence (11-15%)

            1-10%

            Respiratory disorders

            Nausea

            Constipation

            Dyspepsia

            Dizziness

            EPS

            Rash

            Tachycardia

            Orthostatic hypotension

            Diarrhea

            Anorexia

            Myalgia

            Rhinitis

            Cough

            <1%

            Syncope

            Seizures

            Frequency Not Defined

            QT interval prolongation

            Neuroleptic malignant syndrome

            Hyperprolactinemia

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            Contraindications & Cautions

            Black Box Warnings

            Patients with dementia-related psychosis who are treated with antipsychotic drugs are at an increased risk of death as shown in short-term controlled trials. The deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature.

            This drug is not approved for the treatment of patients with dementia-related psychosis.

            Contraindications

            Documented hypersensitivity

            Any drugs or conditions that prolong QT interval

            Cautions

            Prolongs QT/QTc (caution in patients with known risk factors eg, hypomagnesemia, hypokalemia); caution in seizure disorders; may cause hypotension, extrapyramidal symptoms, and somnolence; hyperglycemia may occur and in some cases be extreme, resulting in ketoacidosis, hyperosmolar coma, or death

            Monitor blood glucose of high-risk pts

            FDA Warning regarding off-label use for dementia in elderly

            Leukopenia/neutropenia and agranulocytosis reported; possible risk factors for leukopenia/neutropenia include pre-existing low white blood cell count (WBC) and history of drug-induced leukopenia/neutropenia ( if history of clinically significant low WBC or drug-induced leukopenia/neutropenia, monitor complete blood count (CBC) frequently during first few months of therapy; discontinue drug at first sign of a clinically significant decline <1000/mm3 in WBC in absence of other causative factors and continue monitoring WBC until recovery)

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            Pregnancy & Lactation

            Pregnancy Category: C

            Neonates exposed to antipsychotic drugs during the 3rd trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery

            These complications vary in severity; in some cases, symptoms have been self-limited, while in other cases neonates have required intensive care unit support and prolonged hospitalization

            Lactation: unknown; avoid

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Half-Life: 7 hr (PO), 2-5 hr (IM)

            Peak Plasma Time: 6-8 hr (PO), 60 min (IM)

            Bioavailability: 60% (PO), 100% (IM)

            Protein Bound: 99%

            Vd: 1.5 L/kg

            Metabolism: liver

            Total Body Clearance: 7.5 mL/min/kg

            Excretion

            Urine: 20%

            Feces: 66%

            Mechanism of Action

            Antagonist at dopamine (D2), serotonin (5HT1D, 5HT2A) receptors

            Agonist at serotonin 5HT1A receptor

            Also has alpha-blocking & antihistaminic activity

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            Pricing & Images

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