ziprasidone (Rx)

Brand and Other Names:Geodon
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 20mg
  • 40mg
  • 60mg
  • 80mg

powder for injection

  • 20mg
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Schizophrenia

20 mg PO q12hr with food initially; may be increased every other day PRN; not to exceed 80 mg q12hr

Periodically assess need for maintenance; clinical trials have documented no added benefit with doses above 20 mg q12hr

Acute Agitation With Schizophrenia

IM: 10 mg q2hr or 20 mg q4hr; not to exceed 40 mg/day; use IM for up to 3 days, and switch to PO if continuing past this time

Bipolar I Disorder

Acute treatment of manic or mixed episodes; maintenance therapy as adjunct to lithium or valproate

Acute treatment: 40 mg PO q12hr with food initially; on day 2, may be increased if necessary to 60-80 mg PO q12hr; adjust dose according to tolerance and efficacy within range of 40-80 mg q12hr

Maintenance: Continue at same dose at which patient was initially stabilized; periodically reassess need for maintenance therapy

Dosing Modifications

Renal impairment: Dose adjustment not necessary with PO administration; caution required with IM administration

Hepatic impairment: Use caution; drug undergoes extensive hepatic metabolism, which can increase systemic exposure

Dosage Forms & Strengths

capsule

  • 20mg
  • 40mg
  • 60mg
  • 80mg

powder for injection

  • 20mg
more...

Tourette Syndrome (Off-label)

Days 1-3: 5 mg/day

Days 4-28: Titrate to 40 mg/day divided q12hr

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Interactions

Interaction Checker

and ziprasidone

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%)

            Headache (11%)

            Nausea (4-12%)

            Extrapyramidal symptoms (2-31%)

            Dizziness (3-16%)

            1-10%

            Respiratory disorders (1-8%)

            Constipation (2-9%)

            Dyspepsia (1-8%)

            Rash (4-5%)

            Tachycardia (2%)

            Hypoesthesia (2%)

            Priapism (1%)

            Orthostatic hypotension (5%)

            Xerostomia (1-5%)

            Anorexia (2%)

            Myalgia (2%)

            Rhinitis (1-4%)

            Cough (3%)

            <1%

            Syncope

            Seizures

            Frequency Not Defined

            Prolongation of QT interval

            Neuroleptic malignant syndrome (NMS)

            Hyperprolactinemia

            Drug reaction with eosinophilia and systemic syntoms

            Postmarketing reports

            Stevens-Johnson syndrome

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            Warnings

            Black Box Warnings

            Not approved for dementia-related psychosis; patients with dementia-related psychosis who are treated with antipsychotic drugs are at increased risk of death, as shown in short-term controlled trials; deaths in these trials appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature

            Contraindications

            Documented hypersensitivity

            Any drugs or conditions that prolong QT interval

            Recent acute myocardial infarction

            Uncompensated heart failure

            Cautions

            Seizure disorders; may cause hypotension, EPS, somnolence, and sensory instability, which could lead to falls and, consequently, fractures or other injuries; for patients with diseases, conditions, or medications that could exacerbate these effects, complete fall risk assessments when initiating antipsychotic treatment and recurrently for patients on long-term antipsychotic therapy

            Atypical antipsychotics have been associated with metabolic changes (eg, hyperglycemia, dyslipidemia, and body weight gain) that may increase cardiovascular/cerebrovascular risk

            Hyperglycemia may occur and in some cases may be extreme, resulting in ketoacidosis, hyperosmolar coma, or death; monitor blood glucose of high-risk patients

            Neuroleptic malignant syndrome reported with antipsychotic drugs

            Tardive dyskinesia, acute dystonic reactions, pseudoparkinsonism, or akathisia may develop acutely or chronically

            Discontinue if rash develops without an identified cause

            Drug reaction with eosinophilia and systemic symptoms (DRESS) reported; DRESS consists of combination of three or more of the following: cutaneous reaction (such as rash or exfoliative dermatitis), eosinophilia, fever, lymphadenopathy and one or more systemic complications such as hepatitis, nephritis, pneumonitis, myocarditis, and pericarditis; DRESS is sometimes fatal; discontinue therapy if DRESS suspected

            Cutaneous adverse reactions, such as Stevens-Johnson syndrome, reported; severe cutaneous adverse reactions are sometimes fatal; discontinue therapy if suspected

            Rare cases of priapism reported

            FDA warning regarding off-label use for dementia in elderly (see Black Box Warnings)

            May cause orthostatic hypotension

            Suicide attempt is inherent in psychotic illness or bipolar disorder, close supervision of high-risk patients should accompany drug therapy

            Dopamine2 antagonists may elevate prolactin levels; long-standing hyperprolactinemia when associated with hypogonadism may lead to decreased bone density

            Leukopenia/neutropenia and agranulocytosis reported; possible risk factors for leukopenia/neutropenia include preexisting low white blood cell (WBC) count and history of drug-induced leukopenia/neutropenia

            If patient has history of clinically significant low WBC count or drug-induced leukopenia/neutropenia, monitor complete blood count (CBC) frequently during first few months of therapy; discontinue drug at first sign of clinically significant WBC decline <1000/μL in absence of other causative factors, and continue monitoring WBC count until recovery

            Antipsychotic agents have been associated with esophageal dysmotility and aspiration; use caution in patients at risk of pneumonia

            May cause QTc prolongation, which has been associated with development of malignant ventricular arrhythmias (torsade de pointes) and sudden death; discontinue therapy in patients with persistent QTc intervals >500 msec; avoid hypokalemia or hypomagnesemia

            Moderate to highly sedative; use caution when required to operate heavy machinery

            May cause core body temperature regulation impairment; use caution with heat exposure, strenuous exercise, dehydration, or taking medications with anticholinergic effects

            Make electrolyte imbalance corrections, especially hypomagnesemia or hypokalemia before and throughout therapy

            Use with caution in hepatic impairment

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            Pregnancy & Lactation

            Pregnancy category: C

            Neonates exposed to antipsychotic drugs during 3rd trimester of pregnancy are at risk for EPS or withdrawal symptoms after delivery; these complications vary in severity, with some being self-limited and others requiring ICU support and prolonged hospitalization

            Lactation: Unknown if excreted in breast milk; not recommended

            Pregnancy Categories

            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

            Mechanism of Action

            Acts as antagonist at dopamine D2 and serotonin type 1 and 2 (5HT1D, 5HT2A) receptors; acts as agonist at serotonin 5HT1A receptor; moderately inhibits reuptake of norepinephrine and serotonin; has alpha-blocking and antihistaminic activity

            Absorption

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

            Peak plasma time: 6-8 hr (PO); ≤60 min (IM)

            Distribution

            Protein bound: 99%

            Vd: 1.5 L/kg

            Metabolism

            Metabolized in liver by CYP3A4 (major) and CYP1A2 (minor)

            Elimination

            Half-life: 7 hr (PO); 2-5 hr (IM)

            Total body clearance: 7.5 mL/min/kg

            Excretion: Feces (66%), urine (20%)

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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