ziprasidone (Rx)

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

Tourette Syndrome (Off-label)

Days 1-3: 5 mg/day

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

Contraindicated (19)

• amiodarone

  amiodarone and ziprasidone both increase QTc interval. Contraindicated.

• amisulpride

  amisulpride, ziprasidone. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndromeIncreases risk of neuroleptic malignant syndrome.

• amoxapine

  ziprasidone and amoxapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Contraindicated.

• arsenic trioxide

  arsenic trioxide and ziprasidone both increase QTc interval. Contraindicated.

• citalopram

  ziprasidone and citalopram both increase QTc interval. Contraindicated.

• disopyramide

  disopyramide and ziprasidone both increase QTc interval. Contraindicated.

• escitalopram

  escitalopram and ziprasidone both increase QTc interval. Contraindicated.
  
  ziprasidone and escitalopram both increase QTc interval. Contraindicated.

• goserelin

  goserelin increases toxicity of ziprasidone by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• ibutilide

  ibutilide and ziprasidone both increase QTc interval. Contraindicated.

• indapamide

  indapamide and ziprasidone both increase QTc interval. Contraindicated.

• leuprolide

  leuprolide increases toxicity of ziprasidone by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• pentamidine

  pentamidine and ziprasidone both increase QTc interval. Contraindicated.

• pimozide

  pimozide and ziprasidone both increase QTc interval. Contraindicated.

• procainamide

  procainamide and ziprasidone both increase QTc interval. Contraindicated.

• quinidine

  quinidine and ziprasidone both increase QTc interval. Contraindicated.

• saquinavir

  ziprasidone increases toxicity of saquinavir by QTc interval. Contraindicated. Potential for serious and/or life threatening reactions such as cardiac arrhythmias.

• sorafenib

  sorafenib and ziprasidone both increase QTc interval. Contraindicated.

• sotalol

  sotalol and ziprasidone both increase QTc interval. Contraindicated.

• toremifene

  ziprasidone and toremifene both increase QTc interval. Contraindicated. Concurrent use of ziprasidone with other agents that prolong QTc interval is contraindicated.

Serious - Use Alternative (128)

• adagrasib

  adagrasib, ziprasidone. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• alfuzosin

  alfuzosin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  amisulpride and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  amitriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• amoxapine

  amoxapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• anagrelide

  anagrelide and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• apomorphine

  ziprasidone decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
  
  apomorphine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• aripiprazole

  aripiprazole and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• artemether

  artemether and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  artemether/lumefantrine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine

  asenapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine transdermal

  asenapine transdermal and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• atomoxetine

  atomoxetine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• bromocriptine

  ziprasidone decreases effects of bromocriptine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

• buprenorphine

  buprenorphine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  buprenorphine buccal and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  buprenorphine transdermal and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  buprenorphine, long-acting injection and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• cabergoline

  ziprasidone decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

• calcium/magnesium/potassium/sodium oxybates

  ziprasidone, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• ceritinib

  ceritinib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• chloroquine

  chloroquine increases toxicity of ziprasidone by QTc interval. Avoid or Use Alternate Drug.

• chlorpromazine

  chlorpromazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• citalopram

  citalopram and ziprasidone both increase QTc interval. Contraindicated.

• clarithromycin

  clarithromycin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• clomipramine

  clomipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• clozapine

  clozapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• degarelix

  degarelix and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  desipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• dofetilide

  dofetilide and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• donepezil

  donepezil and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• dopamine

  ziprasidone decreases effects of dopamine by pharmacodynamic antagonism. Contraindicated.

• doxepin

  doxepin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• dronedarone

  dronedarone will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  dronedarone and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• droperidol

  droperidol and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• efavirenz

  efavirenz and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• eliglustat

  eliglustat and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• encorafenib

  encorafenib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.

• entrectinib

  ziprasidone and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

• epinephrine

  epinephrine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• epinephrine racemic

  epinephrine racemic and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• eribulin

  eribulin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

• erythromycin base

  erythromycin base and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  erythromycin lactobionate and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  erythromycin stearate and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• fexinidazole

  fexinidazole and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.

• fingolimod

  fingolimod and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• fluconazole

  fluconazole and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• fluphenazine

  fluphenazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• formoterol

  formoterol and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• gadobenate

  gadobenate and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• gemifloxacin

  gemifloxacin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• gilteritinib

  gilteritinib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• glasdegib

  ziprasidone and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

• granisetron

  granisetron and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• haloperidol

  haloperidol and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• histrelin

  histrelin increases toxicity of ziprasidone by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• hydrocodone

  hydrocodone, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• hydroxychloroquine sulfate

  hydroxychloroquine sulfate and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyzine

  hydroxyzine increases toxicity of ziprasidone by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• imipramine

  imipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• inotuzumab

  inotuzumab and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

• isoflurane

  isoflurane and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• itraconazole

  itraconazole and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• ivosidenib

  ivosidenib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

• ketoconazole

  ketoconazole and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• lefamulin

  lefamulin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• levodopa

  ziprasidone decreases effects of levodopa by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

• levodopa inhaled

  ziprasidone decreases effects of levodopa inhaled by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Atypical (2nd generation) antipsychotics inhibit dopamine D2 receptors in varying degrees (clozapine and quetiapine are lower risk). .

• levoketoconazole

  levoketoconazole and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• lisuride

  ziprasidone decreases effects of lisuride by pharmacodynamic antagonism. Contraindicated.

• lithium

  lithium and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• lofepramine

  lofepramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• lonafarnib

  ziprasidone will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

• lorcaserin

  ziprasidone and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lumefantrine

  lumefantrine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• macimorelin

  macimorelin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  maprotiline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• mefloquine

  mefloquine increases toxicity of ziprasidone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• methyldopa

  ziprasidone decreases effects of methyldopa by pharmacodynamic antagonism. Contraindicated.

• metoclopramide intranasal

  ziprasidone, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
  
  ziprasidone increases toxicity of metoclopramide intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive effects, including increased frequency and severity of tardive dyskinesia, other extrapyramidal symptoms, and neuroleptic malignant syndrome.

• mirtazapine

  mirtazapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  mobocertinib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• moxifloxacin

  moxifloxacin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• nilotinib

  nilotinib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• nortriptyline

  nortriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide

  octreotide and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)

  octreotide (Antidote) and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• olanzapine

  olanzapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• olopatadine intranasal

  ziprasidone and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• ondansetron

  ziprasidone and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

• oxaliplatin

  oxaliplatin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• panobinostat

  ziprasidone and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

• perphenazine

  perphenazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• pimavanserin

  pimavanserin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.

• pitolisant

  ziprasidone and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• ponesimod

  ponesimod, ziprasidone. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• pramipexole

  ziprasidone decreases effects of pramipexole by pharmacodynamic antagonism. Contraindicated.

• primaquine

  primaquine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• prochlorperazine

  prochlorperazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• promazine

  promazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• promethazine

  promethazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• protriptyline

  protriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• ribociclib

  ribociclib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• ropinirole

  ziprasidone decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

• safinamide

  ziprasidone decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.

• selinexor

  selinexor, ziprasidone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• sevoflurane

  sevoflurane and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• siponimod

  siponimod and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• sodium oxybate

  ziprasidone, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• solifenacin

  solifenacin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• sufentanil SL

  sufentanil SL, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• sunitinib

  sunitinib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• tacrolimus

  tacrolimus and ziprasidone both increase QTc interval. Contraindicated.

• tetrabenazine

  tetrabenazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• thioridazine

  thioridazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• trazodone

  trazodone and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• trifluoperazine

  trifluoperazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• trimipramine

  trimipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• triptorelin

  triptorelin increases toxicity of ziprasidone by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• umeclidinium bromide/vilanterol inhaled

  ziprasidone increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vandetanib

  ziprasidone, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vemurafenib

  vemurafenib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• vilanterol/fluticasone furoate inhaled

  ziprasidone increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vorinostat

  vorinostat and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

Monitor Closely (360)

• acarbose

  ziprasidone, acarbose. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• aclidinium

  aclidinium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• acrivastine

  acrivastine and ziprasidone both increase sedation. Use Caution/Monitor.

• albiglutide

  ziprasidone, albiglutide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• albuterol

  ziprasidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  albuterol and ziprasidone both increase QTc interval. Use Caution/Monitor.

• alfentanil

  alfentanil and ziprasidone both increase sedation. Use Caution/Monitor.

• alfuzosin

  ziprasidone and alfuzosin both increase QTc interval. Use Caution/Monitor.

• almotriptan

  almotriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• alprazolam

  alprazolam and ziprasidone both increase sedation. Use Caution/Monitor.

• amifostine

  amifostine, ziprasidone. Either increases effects of the other by anti-hypertensive channel blocking. Use Caution/Monitor. Due to its alpha adrenergic antagonism, atypical antipsychotic agents has the potential to enhance the effect of certain antihypertensive agents. Monitor blood pressure and adjust dose accordingly.

• amitriptyline

  ziprasidone and amitriptyline both increase sedation. Use Caution/Monitor.

• amobarbital

  amobarbital and ziprasidone both increase sedation. Use Caution/Monitor.

• amoxapine

  ziprasidone and amoxapine both increase sedation. Use Caution/Monitor.

• anticholinergic/sedative combos

  anticholinergic/sedative combos decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  anticholinergic/sedative combos decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of anticholinergic/sedative combos by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• arformoterol

  ziprasidone increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  arformoterol and ziprasidone both increase QTc interval. Use Caution/Monitor.

• aripiprazole

  aripiprazole and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  aripiprazole and ziprasidone both increase sedation. Use Caution/Monitor.

• armodafinil

  ziprasidone increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• asenapine

  asenapine and ziprasidone both increase sedation. Use Caution/Monitor.

• asenapine transdermal

  asenapine transdermal and ziprasidone both increase sedation. Use Caution/Monitor.

• atogepant

  ziprasidone will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atracurium

  atracurium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  atracurium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• atropine

  atropine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  atropine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of atropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• atropine IV/IM

  ziprasidone increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  atropine IV/IM decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  atropine IV/IM decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

• avapritinib

  ziprasidone will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  avapritinib and ziprasidone both increase sedation. Use Caution/Monitor.

• axitinib

  ziprasidone increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• azelastine

  azelastine and ziprasidone both increase sedation. Use Caution/Monitor.

• azithromycin

  azithromycin and ziprasidone both increase QTc interval. Use Caution/Monitor.

• baclofen

  baclofen and ziprasidone both increase sedation. Use Caution/Monitor.

• bedaquiline

  ziprasidone and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belladonna alkaloids

  belladonna alkaloids decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  belladonna alkaloids decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of belladonna alkaloids by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• belladonna and opium

  belladonna and opium and ziprasidone both increase sedation. Use Caution/Monitor.
  
  belladonna and opium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  belladonna and opium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• benazepril

  ziprasidone, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

• benperidol

  benperidol and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  benperidol and ziprasidone both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen and ziprasidone both increase sedation. Use Caution/Monitor.

• benzphetamine

  ziprasidone increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bosutinib

  bosutinib and ziprasidone both increase QTc interval. Use Caution/Monitor.

• brexanolone

  brexanolone, ziprasidone. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brexpiprazole

  brexpiprazole and ziprasidone both increase sedation. Use Caution/Monitor.

• brimonidine

  brimonidine and ziprasidone both increase sedation. Use Caution/Monitor.

• brivaracetam

  brivaracetam and ziprasidone both increase sedation. Use Caution/Monitor.

• brompheniramine

  brompheniramine and ziprasidone both increase sedation. Use Caution/Monitor.

• buprenorphine

  buprenorphine and ziprasidone both increase sedation. Use Caution/Monitor.

• buprenorphine buccal

  buprenorphine buccal and ziprasidone both increase sedation. Use Caution/Monitor.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and ziprasidone both increase sedation. Use Caution/Monitor.

• buprenorphine transdermal

  buprenorphine transdermal and ziprasidone both increase sedation. Use Caution/Monitor.

• buprenorphine, long-acting injection

  ziprasidone increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

• butabarbital

  butabarbital and ziprasidone both increase sedation. Use Caution/Monitor.

• butalbital

  butalbital and ziprasidone both increase sedation. Use Caution/Monitor.

• butorphanol

  butorphanol and ziprasidone both increase sedation. Use Caution/Monitor.

• caffeine

  ziprasidone increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• capecitabine

  capecitabine and ziprasidone both increase QTc interval. Use Caution/Monitor.

• carbamazepine

  carbamazepine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• carbinoxamine

  carbinoxamine and ziprasidone both increase sedation. Use Caution/Monitor.

• carisoprodol

  carisoprodol and ziprasidone both increase sedation. Use Caution/Monitor.

• cenobamate

  cenobamate, ziprasidone. Either increases effects of the other by sedation. Use Caution/Monitor.

• chloral hydrate

  chloral hydrate and ziprasidone both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  chlordiazepoxide and ziprasidone both increase sedation. Use Caution/Monitor.

• chlorpheniramine

  chlorpheniramine and ziprasidone both increase sedation. Use Caution/Monitor.

• chlorpromazine

  chlorpromazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  chlorpromazine and ziprasidone both increase sedation. Use Caution/Monitor.

• chlorpropamide

  ziprasidone, chlorpropamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• chlorzoxazone

  chlorzoxazone and ziprasidone both increase sedation. Use Caution/Monitor.

• cimetidine

  cimetidine will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cinnarizine

  cinnarizine and ziprasidone both increase sedation. Use Caution/Monitor.

• ciprofloxacin

  ciprofloxacin and ziprasidone both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

• cisatracurium

  cisatracurium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  cisatracurium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• clarithromycin

  clarithromycin will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• clemastine

  clemastine and ziprasidone both increase sedation. Use Caution/Monitor.

• clobazam

  ziprasidone, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clomipramine

  ziprasidone and clomipramine both increase sedation. Use Caution/Monitor.

• clonazepam

  clonazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• clonidine

  clonidine, ziprasidone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.

• clorazepate

  clorazepate and ziprasidone both increase sedation. Use Caution/Monitor.

• clozapine

  clozapine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  clozapine and ziprasidone both increase sedation. Use Caution/Monitor.

• codeine

  codeine and ziprasidone both increase sedation. Use Caution/Monitor.

• crizotinib

  crizotinib and ziprasidone both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• cyclizine

  cyclizine and ziprasidone both increase sedation. Use Caution/Monitor.
  
  cyclizine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  cyclizine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of cyclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• cyclobenzaprine

  cyclobenzaprine and ziprasidone both increase sedation. Use Caution/Monitor.
  
  cyclobenzaprine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  cyclobenzaprine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• cyproheptadine

  cyproheptadine and ziprasidone both increase sedation. Use Caution/Monitor.

• dabrafenib

  dabrafenib and ziprasidone both increase QTc interval. Use Caution/Monitor.

• dantrolene

  dantrolene and ziprasidone both increase sedation. Use Caution/Monitor.

• daridorexant

  ziprasidone and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  darifenacin decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  darifenacin decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of darifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• dasatinib

  dasatinib and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• desflurane

  desflurane and ziprasidone both increase QTc interval. Use Caution/Monitor.

• desipramine

  ziprasidone and desipramine both increase sedation. Use Caution/Monitor.

• deutetrabenazine

  ziprasidone and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.
  
  ziprasidone and deutetrabenazine both increase sedation. Use Caution/Monitor.
  
  ziprasidone and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexchlorpheniramine

  dexchlorpheniramine and ziprasidone both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  ziprasidone increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexmedetomidine

  dexmedetomidine and ziprasidone both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  ziprasidone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine

  ziprasidone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine transdermal

  ziprasidone, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).

• dextromethorphan

  dextromethorphan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• dextromoramide

  dextromoramide and ziprasidone both increase sedation. Use Caution/Monitor.

• diamorphine

  diamorphine and ziprasidone both increase sedation. Use Caution/Monitor.

• diazepam

  diazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• dichlorphenamide

  dichlorphenamide and ziprasidone both decrease serum potassium. Use Caution/Monitor.

• dicyclomine

  dicyclomine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  dicyclomine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of dicyclomine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• diethylpropion

  ziprasidone increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• difelikefalin

  difelikefalin and ziprasidone both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  difenoxin hcl and ziprasidone both increase sedation. Use Caution/Monitor.

• dihydroergotamine

  dihydroergotamine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• dimenhydrinate

  dimenhydrinate and ziprasidone both increase sedation. Use Caution/Monitor.

• diphenhydramine

  diphenhydramine and ziprasidone both increase sedation. Use Caution/Monitor.
  
  diphenhydramine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  diphenhydramine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of diphenhydramine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• diphenoxylate hcl

  diphenoxylate hcl and ziprasidone both increase sedation. Use Caution/Monitor.

• dipipanone

  dipipanone and ziprasidone both increase sedation. Use Caution/Monitor.

• dobutamine

  ziprasidone increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dolasetron

  dolasetron and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• dopamine

  ziprasidone increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopexamine

  ziprasidone increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dosulepin

  ziprasidone and dosulepin both increase sedation. Use Caution/Monitor.

• doxepin

  ziprasidone and doxepin both increase sedation. Use Caution/Monitor.

• doxylamine

  doxylamine and ziprasidone both increase sedation. Use Caution/Monitor.

• droperidol

  droperidol and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  droperidol and ziprasidone both increase sedation. Use Caution/Monitor.

• eletriptan

  eletriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• ephedrine

  ziprasidone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  ziprasidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine racemic

  ziprasidone increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ergoloid mesylates

  ergoloid mesylates, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• ergotamine

  ergotamine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• erythromycin base

  erythromycin base will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erythromycin lactobionate

  erythromycin lactobionate will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erythromycin stearate

  erythromycin stearate will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• esketamine intranasal

  esketamine intranasal, ziprasidone. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• estazolam

  estazolam and ziprasidone both increase sedation. Use Caution/Monitor.

• ethanol

  ziprasidone and ethanol both increase sedation. Use Caution/Monitor.

• etomidate

  etomidate and ziprasidone both increase sedation. Use Caution/Monitor.

• exenatide injectable solution

  ziprasidone, exenatide injectable solution. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• exenatide injectable suspension

  ziprasidone, exenatide injectable suspension. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• ezogabine

  ezogabine, ziprasidone. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fenfluramine

  ziprasidone increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  ziprasidone decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

• fentanyl

  fentanyl, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• fesoterodine

  fesoterodine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  fesoterodine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of fesoterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• finerenone

  ziprasidone will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

• flavoxate

  flavoxate decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  flavoxate decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of flavoxate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• flecainide

  flecainide and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• flibanserin

  ziprasidone will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.
  
  flibanserin, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• floxuridine

  floxuridine and ziprasidone both increase QTc interval. Use Caution/Monitor.

• fluoxetine

  fluoxetine and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• fluphenazine

  fluphenazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  fluphenazine and ziprasidone both increase sedation. Use Caution/Monitor.

• flurazepam

  flurazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• fluvoxamine

  fluvoxamine and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• formoterol

  ziprasidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• foscarnet

  foscarnet and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• fostemsavir

  ziprasidone and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• frovatriptan

  frovatriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• ganaxolone

  ziprasidone and ganaxolone both increase sedation. Use Caution/Monitor.

• gemtuzumab

  ziprasidone and gemtuzumab both increase QTc interval. Use Caution/Monitor.

• glimepiride

  ziprasidone, glimepiride. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• glipizide

  ziprasidone, glipizide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• glyburide

  ziprasidone, glyburide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• glycopyrrolate

  ziprasidone increases effects of glycopyrrolate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• glycopyrrolate inhaled

  glycopyrrolate inhaled decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  glycopyrrolate inhaled decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• guanfacine

  guanfacine, ziprasidone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.

• haloperidol

  haloperidol and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  haloperidol and ziprasidone both increase sedation. Use Caution/Monitor.

• henbane

  henbane decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  henbane decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of henbane by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• homatropine

  homatropine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  homatropine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of homatropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• hydromorphone

  hydromorphone and ziprasidone both increase sedation. Use Caution/Monitor.

• hydroxyzine

  hydroxyzine and ziprasidone both increase sedation. Use Caution/Monitor.

• hyoscyamine

  hyoscyamine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  hyoscyamine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• hyoscyamine spray

  ziprasidone increases effects of hyoscyamine spray by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  hyoscyamine spray decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  hyoscyamine spray decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

• iloperidone

  iloperidone and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  iloperidone and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  iloperidone and ziprasidone both increase sedation. Use Caution/Monitor.

• imipramine

  ziprasidone and imipramine both increase sedation. Use Caution/Monitor.

• indacaterol, inhaled

  indacaterol, inhaled, ziprasidone. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• insulin aspart

  ziprasidone, insulin aspart. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• insulin degludec

  ziprasidone decreases effects of insulin degludec by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

• insulin degludec/insulin aspart

  ziprasidone decreases effects of insulin degludec/insulin aspart by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

• insulin detemir

  ziprasidone, insulin detemir. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• insulin glargine

  ziprasidone, insulin glargine. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• insulin glulisine

  ziprasidone, insulin glulisine. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• insulin inhaled

  ziprasidone decreases effects of insulin inhaled by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

• insulin lispro

  ziprasidone, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• insulin NPH

  ziprasidone, insulin NPH. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• insulin regular human

  ziprasidone, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• ipratropium

  ipratropium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  ipratropium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• isavuconazonium sulfate

  ziprasidone will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• isoproterenol

  ziprasidone increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• itraconazole

  itraconazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ivacaftor

  ziprasidone increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

• ketoconazole

  ketoconazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ketotifen, ophthalmic

  ziprasidone and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• lapatinib

  lapatinib and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• lasmiditan

  lasmiditan, ziprasidone. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

• lemborexant

  ziprasidone will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.
  
  lemborexant, ziprasidone. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• lenvatinib

  ziprasidone and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

• letermovir

  letermovir increases levels of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levalbuterol

  ziprasidone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levofloxacin

  levofloxacin and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• levoketoconazole

  levoketoconazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levomilnacipran

  levomilnacipran, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• levorphanol

  levorphanol and ziprasidone both increase sedation. Use Caution/Monitor.

• linezolid

  linezolid, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• liraglutide

  ziprasidone, liraglutide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• lisdexamfetamine

  ziprasidone increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lithium

  lithium, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• lofepramine

  ziprasidone and lofepramine both increase sedation. Use Caution/Monitor.

• lofexidine

  ziprasidone and lofexidine both increase sedation. Use Caution/Monitor.
  
  ziprasidone and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended.

• lomitapide

  ziprasidone increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

• loprazolam

  loprazolam and ziprasidone both increase sedation. Use Caution/Monitor.

• lorazepam

  lorazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• lorcaserin

  lorcaserin, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• lormetazepam

  lormetazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• loxapine

  loxapine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  loxapine and ziprasidone both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  loxapine inhaled and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  loxapine inhaled and ziprasidone both increase sedation. Use Caution/Monitor.

• lurasidone

  lurasidone, ziprasidone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

• maprotiline

  ziprasidone and maprotiline both increase sedation. Use Caution/Monitor.

• maraviroc

  maraviroc, ziprasidone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

• marijuana

  ziprasidone and marijuana both increase sedation. Use Caution/Monitor.

• meclizine

  meclizine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  meclizine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of meclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• melatonin

  ziprasidone and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  meperidine and ziprasidone both increase sedation. Use Caution/Monitor.
  
  meperidine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• meprobamate

  ziprasidone and meprobamate both increase sedation. Use Caution/Monitor.

• metaproterenol

  ziprasidone increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaxalone

  metaxalone and ziprasidone both increase sedation. Use Caution/Monitor.

• metformin

  ziprasidone, metformin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• methadone

  methadone and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  methadone and ziprasidone both increase sedation. Use Caution/Monitor.
  
  methadone, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• methamphetamine

  ziprasidone increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methocarbamol

  methocarbamol and ziprasidone both increase sedation. Use Caution/Monitor.

• methscopolamine

  methscopolamine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  methscopolamine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of methscopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• methylenedioxymethamphetamine

  ziprasidone increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methylergonovine

  methylergonovine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• methylphenidate

  ziprasidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

• metoclopramide

  ziprasidone and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

• midazolam

  midazolam and ziprasidone both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  midazolam intranasal, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  ziprasidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mifepristone

  mifepristone, ziprasidone. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• miglitol

  ziprasidone, miglitol. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• milnacipran

  milnacipran, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• mirtazapine

  ziprasidone and mirtazapine both increase sedation. Use Caution/Monitor.

• modafinil

  ziprasidone increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  morphine and ziprasidone both increase sedation. Use Caution/Monitor.

• motherwort

  ziprasidone and motherwort both increase sedation. Use Caution/Monitor.

• moxonidine

  ziprasidone and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  ziprasidone and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  nalbuphine and ziprasidone both increase sedation. Use Caution/Monitor.

• naratriptan

  naratriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• nateglinide

  ziprasidone, nateglinide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• nefazodone

  nefazodone will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• norepinephrine

  ziprasidone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nortriptyline

  ziprasidone and nortriptyline both increase sedation. Use Caution/Monitor.

• ofloxacin

  ofloxacin and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine

  olanzapine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  olanzapine and ziprasidone both increase sedation. Use Caution/Monitor.

• oliceridine

  oliceridine, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• olodaterol inhaled

  ziprasidone and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• onabotulinumtoxinA

  onabotulinumtoxinA decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  onabotulinumtoxinA decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• opium tincture

  opium tincture and ziprasidone both increase sedation. Use Caution/Monitor.

• orphenadrine

  orphenadrine and ziprasidone both increase sedation. Use Caution/Monitor.

• osilodrostat

  osilodrostat and ziprasidone both increase QTc interval. Use Caution/Monitor.

• osimertinib

  osimertinib and ziprasidone both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxaliplatin

  oxaliplatin will increase the level or effect of ziprasidone by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

• oxazepam

  oxazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• oxybutynin

  oxybutynin decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  oxybutynin decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of oxybutynin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• oxybutynin topical

  oxybutynin topical decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  oxybutynin topical decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of oxybutynin topical by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• oxybutynin transdermal

  oxybutynin transdermal decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  oxybutynin transdermal decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of oxybutynin transdermal by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• oxycodone

  oxycodone and ziprasidone both increase sedation. Use Caution/Monitor.

• oxymorphone

  oxymorphone and ziprasidone both increase sedation. Use Caution/Monitor.

• ozanimod

  ozanimod and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• paliperidone

  paliperidone and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  paliperidone and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  paliperidone and ziprasidone both increase sedation. Use Caution/Monitor.

• pancuronium

  pancuronium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  pancuronium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of pancuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• papaveretum

  papaveretum and ziprasidone both increase sedation. Use Caution/Monitor.

• papaverine

  ziprasidone and papaverine both increase sedation. Use Caution/Monitor.

• paroxetine

  paroxetine and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  paroxetine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• pasireotide

  ziprasidone and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  pazopanib and ziprasidone both increase QTc interval. Use Caution/Monitor.

• pentazocine

  pentazocine and ziprasidone both increase sedation. Use Caution/Monitor.

• pentobarbital

  pentobarbital and ziprasidone both increase sedation. Use Caution/Monitor.

• perphenazine

  perphenazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  perphenazine and ziprasidone both increase sedation. Use Caution/Monitor.

• phendimetrazine

  ziprasidone increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenelzine

  phenelzine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• phenobarbital

  phenobarbital and ziprasidone both increase sedation. Use Caution/Monitor.

• phentermine

  ziprasidone increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine

  ziprasidone increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine PO

  ziprasidone increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• pholcodine

  ziprasidone and pholcodine both increase sedation. Use Caution/Monitor.

• pimozide

  pimozide and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and ziprasidone both increase sedation. Use Caution/Monitor.

• pioglitazone

  ziprasidone, pioglitazone. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• pirbuterol

  ziprasidone increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• posaconazole

  posaconazole and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• pralidoxime

  pralidoxime decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  pralidoxime decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• pramlintide

  ziprasidone, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• primidone

  primidone and ziprasidone both increase sedation. Use Caution/Monitor.

• procarbazine

  procarbazine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• prochlorperazine

  prochlorperazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  prochlorperazine and ziprasidone both increase sedation. Use Caution/Monitor.

• promethazine

  promethazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  promethazine and ziprasidone both increase sedation. Use Caution/Monitor.
  
  promethazine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• propantheline

  propantheline decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  propantheline decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of propantheline by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• propofol

  propofol and ziprasidone both increase sedation. Use Caution/Monitor.

• propylhexedrine

  ziprasidone increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protriptyline

  ziprasidone and protriptyline both increase sedation. Use Caution/Monitor.

• quazepam

  quazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• quetiapine

  quetiapine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  quetiapine and ziprasidone both increase sedation. Use Caution/Monitor.
  
  quetiapine, ziprasidone. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinine

  ziprasidone and quinine both increase QTc interval. Use Caution/Monitor.

• ramelteon

  ziprasidone and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  ranolazine and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• rapacuronium

  rapacuronium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  rapacuronium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of rapacuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• remimazolam

  remimazolam, ziprasidone. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• repaglinide

  ziprasidone, repaglinide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• rifabutin

  rifabutin will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin

  rifampin will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rilpivirine

  rilpivirine increases toxicity of ziprasidone by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

• risperidone

  risperidone and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  risperidone and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  risperidone and ziprasidone both increase sedation. Use Caution/Monitor.

• rocuronium

  rocuronium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  rocuronium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of rocuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• romidepsin

  romidepsin and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely. Avoid using ziprasidone with other QTc prolonging agents.

• rosiglitazone

  ziprasidone, rosiglitazone. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• salmeterol

  ziprasidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• saxagliptin

  ziprasidone, saxagliptin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• scopolamine

  scopolamine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  scopolamine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• scullcap

  ziprasidone and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  secobarbital and ziprasidone both increase sedation. Use Caution/Monitor.

• selegiline

  selegiline, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• selpercatinib

  selpercatinib increases toxicity of ziprasidone by QTc interval. Use Caution/Monitor.

• sertraline

  sertraline and ziprasidone both decrease QTc interval. Modify Therapy/Monitor Closely.

• shepherd's purse

  ziprasidone and shepherd's purse both increase sedation. Use Caution/Monitor.

• sitagliptin

  ziprasidone, sitagliptin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of ziprasidone by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
  
  sodium sulfate/?magnesium sulfate/potassium chloride increases effects of ziprasidone by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of ziprasidone by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
  
  sodium sulfate/potassium sulfate/magnesium sulfate increases effects of ziprasidone by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

• solifenacin

  solifenacin decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  solifenacin decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• St John's Wort

  St John's Wort will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• stiripentol

  stiripentol, ziprasidone. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• sufentanil

  sufentanil and ziprasidone both increase sedation. Use Caution/Monitor.

• sulfamethoxazole

  sulfamethoxazole and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• sumatriptan

  sumatriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• sumatriptan intranasal

  sumatriptan intranasal, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• tapentadol

  tapentadol and ziprasidone both increase sedation. Use Caution/Monitor.

• tazemetostat

  ziprasidone will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• telavancin

  telavancin and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• temazepam

  temazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• terbutaline

  ziprasidone increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tetrabenazine

  ziprasidone and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.

• thioridazine

  thioridazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  thioridazine and ziprasidone both increase sedation. Use Caution/Monitor.

• thiothixene

  thiothixene and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  thiothixene and ziprasidone both increase sedation. Use Caution/Monitor.

• tinidazole

  ziprasidone will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tiotropium

  tiotropium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  tiotropium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• tolazamide

  ziprasidone, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• tolbutamide

  ziprasidone, tolbutamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• tolterodine

  tolterodine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  tolterodine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• topiramate

  ziprasidone and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  tramadol and ziprasidone both increase sedation. Use Caution/Monitor.

• tranylcypromine

  tranylcypromine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• trazodone

  ziprasidone and trazodone both increase sedation. Use Caution/Monitor.

• triazolam

  triazolam and ziprasidone both increase sedation. Use Caution/Monitor.

• triclabendazole

  triclabendazole and ziprasidone both increase QTc interval. Use Caution/Monitor.

• triclofos

  triclofos and ziprasidone both increase sedation. Use Caution/Monitor.

• trifluoperazine

  trifluoperazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  trifluoperazine and ziprasidone both increase sedation. Use Caution/Monitor.

• trimethoprim

  trimethoprim and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• trimipramine

  ziprasidone and trimipramine both increase sedation. Use Caution/Monitor.

• triprolidine

  triprolidine and ziprasidone both increase sedation. Use Caution/Monitor.

• tropisetron

  tropisetron and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• trospium chloride

  trospium chloride decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  trospium chloride decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• vecuronium

  vecuronium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  vecuronium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• venlafaxine

  venlafaxine and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  venlafaxine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• vilazodone

  vilazodone, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• voclosporin

  voclosporin, ziprasidone. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  voriconazole and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• xylometazoline

  ziprasidone increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• yohimbine

  ziprasidone increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziconotide

  ziprasidone and ziconotide both increase sedation. Use Caution/Monitor.

• zolmitriptan

  zolmitriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• zotepine

  ziprasidone and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  ziprasidone and zotepine both increase sedation. Use Caution/Monitor.

Minor (64)

• amobarbital

  amobarbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• aprepitant

  aprepitant will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• armodafinil

  armodafinil will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• artemether/lumefantrine

  artemether/lumefantrine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• atazanavir

  atazanavir will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• bosentan

  bosentan will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• brimonidine

  brimonidine increases effects of ziprasidone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• budesonide

  budesonide will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• butabarbital

  butabarbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• butalbital

  butalbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• chasteberry

  chasteberry decreases effects of ziprasidone by pharmacodynamic antagonism. Minor/Significance Unknown. (Theoretical interaction).

• conivaptan

  conivaptan will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cortisone

  cortisone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cyclosporine

  cyclosporine will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• darifenacin

  darifenacin will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• darunavir

  darunavir will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dasatinib

  dasatinib will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dexamethasone

  dexamethasone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• DHEA, herbal

  DHEA, herbal will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• efavirenz

  efavirenz will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eslicarbazepine acetate

  eslicarbazepine acetate will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ethanol

  ethanol, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• etravirine

  etravirine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eucalyptus

  ziprasidone and eucalyptus both increase sedation. Minor/Significance Unknown.

• fluconazole

  fluconazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fludrocortisone

  fludrocortisone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fosamprenavir

  fosamprenavir will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fosaprepitant

  fosaprepitant will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fosphenytoin

  fosphenytoin will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• grapefruit

  grapefruit will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• griseofulvin

  griseofulvin will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• hydrocortisone

  hydrocortisone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• indinavir

  indinavir will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• isoniazid

  isoniazid will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lapatinib

  lapatinib will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lumefantrine

  lumefantrine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• marijuana

  marijuana will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• methylprednisolone

  methylprednisolone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• metronidazole

  metronidazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• miconazole vaginal

  miconazole vaginal will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nafcillin

  nafcillin will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nelfinavir

  nelfinavir will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nevirapine

  nevirapine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nifedipine

  nifedipine will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nilotinib

  nilotinib will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• oxcarbazepine

  oxcarbazepine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• pentobarbital

  pentobarbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• phenobarbital

  phenobarbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• phenytoin

  phenytoin will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• posaconazole

  posaconazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• prednisone

  prednisone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• primidone

  primidone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• quinupristin/dalfopristin

  quinupristin/dalfopristin will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• rifapentine

  rifapentine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ritonavir

  ritonavir will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• rufinamide

  rufinamide will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib

  ziprasidone will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib topical

  ziprasidone will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• sage

  ziprasidone and sage both increase sedation. Minor/Significance Unknown.

• secobarbital

  secobarbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• topiramate

  topiramate will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• verapamil

  verapamil will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• voriconazole

  voriconazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• zafirlukast

  zafirlukast will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• acarbose

  Monitor Closely (1)ziprasidone, acarbose. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• aclidinium

  Monitor Closely (2)aclidinium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of aclidinium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• acrivastine

  Monitor Closely (1)acrivastine and ziprasidone both increase sedation. Use Caution/Monitor.

• adagrasib

  Serious - Use Alternative (1)adagrasib, ziprasidone. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• albiglutide

  Monitor Closely (1)ziprasidone, albiglutide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• albuterol

  Monitor Closely (2)ziprasidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  albuterol and ziprasidone both increase QTc interval. Use Caution/Monitor.

• alfentanil

  Monitor Closely (1)alfentanil and ziprasidone both increase sedation. Use Caution/Monitor.

• alfuzosin

  Monitor Closely (1)ziprasidone and alfuzosin both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)alfuzosin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• almotriptan

  Monitor Closely (1)almotriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• alprazolam

  Monitor Closely (1)alprazolam and ziprasidone both increase sedation. Use Caution/Monitor.

• amifostine

  Monitor Closely (1)amifostine, ziprasidone. Either increases effects of the other by anti-hypertensive channel blocking. Use Caution/Monitor. Due to its alpha adrenergic antagonism, atypical antipsychotic agents has the potential to enhance the effect of certain antihypertensive agents. Monitor blood pressure and adjust dose accordingly.

• amiodarone

  Contraindicated (1)amiodarone and ziprasidone both increase QTc interval. Contraindicated.

• amisulpride

  Contraindicated (1)amisulpride, ziprasidone. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndromeIncreases risk of neuroleptic malignant syndrome.Serious - Use Alternative (1)amisulpride and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  Monitor Closely (1)ziprasidone and amitriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amitriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• amobarbital

  Monitor Closely (1)amobarbital and ziprasidone both increase sedation. Use Caution/Monitor.Minor (1)amobarbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• amoxapine

  Contraindicated (1)ziprasidone and amoxapine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Contraindicated.Monitor Closely (1)ziprasidone and amoxapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)amoxapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• anagrelide

  Serious - Use Alternative (1)anagrelide and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• anticholinergic/sedative combos

  Monitor Closely (3)anticholinergic/sedative combos decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  anticholinergic/sedative combos decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of anticholinergic/sedative combos by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• apomorphine

  Serious - Use Alternative (2)ziprasidone decreases effects of apomorphine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
  
  apomorphine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• aprepitant

  Minor (1)aprepitant will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• arformoterol

  Monitor Closely (2)ziprasidone increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  arformoterol and ziprasidone both increase QTc interval. Use Caution/Monitor.

• aripiprazole

  Monitor Closely (2)aripiprazole and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  aripiprazole and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)aripiprazole and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• armodafinil

  Monitor Closely (1)ziprasidone increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)armodafinil will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• arsenic trioxide

  Contraindicated (1)arsenic trioxide and ziprasidone both increase QTc interval. Contraindicated.

• artemether

  Serious - Use Alternative (1)artemether and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  Serious - Use Alternative (1)artemether/lumefantrine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)artemether/lumefantrine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• asenapine

  Monitor Closely (1)asenapine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)asenapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine transdermal

  Monitor Closely (1)asenapine transdermal and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)asenapine transdermal and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• atazanavir

  Minor (1)atazanavir will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• atogepant

  Monitor Closely (1)ziprasidone will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atomoxetine

  Serious - Use Alternative (1)atomoxetine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• atracurium

  Monitor Closely (3)atracurium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  atracurium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of atracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• atropine

  Monitor Closely (3)atropine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  atropine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of atropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• atropine IV/IM

  Monitor Closely (3)ziprasidone increases effects of atropine IV/IM by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  atropine IV/IM decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  atropine IV/IM decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

• avapritinib

  Monitor Closely (2)ziprasidone will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  avapritinib and ziprasidone both increase sedation. Use Caution/Monitor.

• axitinib

  Monitor Closely (1)ziprasidone increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• azelastine

  Monitor Closely (1)azelastine and ziprasidone both increase sedation. Use Caution/Monitor.

• azithromycin

  Monitor Closely (1)azithromycin and ziprasidone both increase QTc interval. Use Caution/Monitor.

• baclofen

  Monitor Closely (1)baclofen and ziprasidone both increase sedation. Use Caution/Monitor.

• bedaquiline

  Monitor Closely (1)ziprasidone and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belladonna alkaloids

  Monitor Closely (3)belladonna alkaloids decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  belladonna alkaloids decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of belladonna alkaloids by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• belladonna and opium

  Monitor Closely (4)belladonna and opium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  belladonna and opium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of belladonna and opium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  belladonna and opium and ziprasidone both increase sedation. Use Caution/Monitor.

• benazepril

  Monitor Closely (1)ziprasidone, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Enhanced hypotensive effects.

• benperidol

  Monitor Closely (2)benperidol and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  benperidol and ziprasidone both increase sedation. Use Caution/Monitor.

• benzhydrocodone/acetaminophen

  Monitor Closely (1)benzhydrocodone/acetaminophen and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)benzhydrocodone/acetaminophen, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• benzphetamine

  Monitor Closely (1)ziprasidone increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bosentan

  Minor (1)bosentan will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• bosutinib

  Monitor Closely (1)bosutinib and ziprasidone both increase QTc interval. Use Caution/Monitor.

• brexanolone

  Monitor Closely (1)brexanolone, ziprasidone. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brexpiprazole

  Monitor Closely (1)brexpiprazole and ziprasidone both increase sedation. Use Caution/Monitor.

• brimonidine

  Monitor Closely (1)brimonidine and ziprasidone both increase sedation. Use Caution/Monitor.Minor (1)brimonidine increases effects of ziprasidone by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• brivaracetam

  Monitor Closely (1)brivaracetam and ziprasidone both increase sedation. Use Caution/Monitor.

• bromocriptine

  Serious - Use Alternative (1)ziprasidone decreases effects of bromocriptine by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

• brompheniramine

  Monitor Closely (1)brompheniramine and ziprasidone both increase sedation. Use Caution/Monitor.

• budesonide

  Minor (1)budesonide will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• buprenorphine

  Monitor Closely (1)buprenorphine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  Monitor Closely (1)buprenorphine buccal and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine buccal and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  Monitor Closely (1)buprenorphine subdermal implant and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine subdermal implant and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  Monitor Closely (1)buprenorphine transdermal and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)buprenorphine transdermal and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  Monitor Closely (1)ziprasidone increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.Serious - Use Alternative (1)buprenorphine, long-acting injection and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• butabarbital

  Monitor Closely (1)butabarbital and ziprasidone both increase sedation. Use Caution/Monitor.Minor (1)butabarbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• butalbital

  Monitor Closely (1)butalbital and ziprasidone both increase sedation. Use Caution/Monitor.Minor (1)butalbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• butorphanol

  Monitor Closely (1)butorphanol and ziprasidone both increase sedation. Use Caution/Monitor.

• cabergoline

  Serious - Use Alternative (1)ziprasidone decreases effects of cabergoline by pharmacodynamic antagonism. Contraindicated.

• caffeine

  Monitor Closely (1)ziprasidone increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• calcium/magnesium/potassium/sodium oxybates

  Serious - Use Alternative (1)ziprasidone, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• capecitabine

  Monitor Closely (1)capecitabine and ziprasidone both increase QTc interval. Use Caution/Monitor.

• carbamazepine

  Monitor Closely (1)carbamazepine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• carbinoxamine

  Monitor Closely (1)carbinoxamine and ziprasidone both increase sedation. Use Caution/Monitor.

• carisoprodol

  Monitor Closely (1)carisoprodol and ziprasidone both increase sedation. Use Caution/Monitor.

• cenobamate

  Monitor Closely (1)cenobamate, ziprasidone. Either increases effects of the other by sedation. Use Caution/Monitor.

• ceritinib

  Serious - Use Alternative (1)ceritinib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• chasteberry

  Minor (1)chasteberry decreases effects of ziprasidone by pharmacodynamic antagonism. Minor/Significance Unknown. (Theoretical interaction).

• chloral hydrate

  Monitor Closely (1)chloral hydrate and ziprasidone both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  Monitor Closely (1)chlordiazepoxide and ziprasidone both increase sedation. Use Caution/Monitor.

• chloroquine

  Serious - Use Alternative (1)chloroquine increases toxicity of ziprasidone by QTc interval. Avoid or Use Alternate Drug.

• chlorpheniramine

  Monitor Closely (1)chlorpheniramine and ziprasidone both increase sedation. Use Caution/Monitor.

• chlorpromazine

  Monitor Closely (2)chlorpromazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  chlorpromazine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)chlorpromazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• chlorpropamide

  Monitor Closely (1)ziprasidone, chlorpropamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• chlorzoxazone

  Monitor Closely (1)chlorzoxazone and ziprasidone both increase sedation. Use Caution/Monitor.

• cimetidine

  Monitor Closely (1)cimetidine will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• cinnarizine

  Monitor Closely (1)cinnarizine and ziprasidone both increase sedation. Use Caution/Monitor.

• ciprofloxacin

  Monitor Closely (1)ciprofloxacin and ziprasidone both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

• cisatracurium

  Monitor Closely (3)cisatracurium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  cisatracurium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of cisatracurium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• citalopram

  Contraindicated (1)ziprasidone and citalopram both increase QTc interval. Contraindicated.Serious - Use Alternative (1)citalopram and ziprasidone both increase QTc interval. Contraindicated.

• clarithromycin

  Monitor Closely (1)clarithromycin will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)clarithromycin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• clemastine

  Monitor Closely (1)clemastine and ziprasidone both increase sedation. Use Caution/Monitor.

• clobazam

  Monitor Closely (1)ziprasidone, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clomipramine

  Monitor Closely (1)ziprasidone and clomipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)clomipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• clonazepam

  Monitor Closely (1)clonazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• clonidine

  Monitor Closely (1)clonidine, ziprasidone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.

• clorazepate

  Monitor Closely (1)clorazepate and ziprasidone both increase sedation. Use Caution/Monitor.

• clozapine

  Monitor Closely (2)clozapine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  clozapine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)clozapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• codeine

  Monitor Closely (1)codeine and ziprasidone both increase sedation. Use Caution/Monitor.

• conivaptan

  Minor (1)conivaptan will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cortisone

  Minor (1)cortisone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• crizotinib

  Monitor Closely (1)crizotinib and ziprasidone both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• cyclizine

  Monitor Closely (4)cyclizine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  cyclizine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of cyclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  cyclizine and ziprasidone both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  Monitor Closely (4)cyclobenzaprine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  cyclobenzaprine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of cyclobenzaprine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  cyclobenzaprine and ziprasidone both increase sedation. Use Caution/Monitor.

• cyclosporine

  Minor (1)cyclosporine will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cyproheptadine

  Monitor Closely (1)cyproheptadine and ziprasidone both increase sedation. Use Caution/Monitor.

• dabrafenib

  Monitor Closely (1)dabrafenib and ziprasidone both increase QTc interval. Use Caution/Monitor.

• dantrolene

  Monitor Closely (1)dantrolene and ziprasidone both increase sedation. Use Caution/Monitor.

• daridorexant

  Monitor Closely (1)ziprasidone and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• darifenacin

  Monitor Closely (3)darifenacin decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  darifenacin decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of darifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.Minor (1)darifenacin will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• darunavir

  Minor (1)darunavir will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dasatinib

  Monitor Closely (1)dasatinib and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)dasatinib will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• degarelix

  Serious - Use Alternative (1)degarelix and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• desflurane

  Monitor Closely (1)desflurane and ziprasidone both increase QTc interval. Use Caution/Monitor.

• desipramine

  Monitor Closely (1)ziprasidone and desipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)desipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• deutetrabenazine

  Monitor Closely (3)ziprasidone and deutetrabenazine both increase sedation. Use Caution/Monitor.
  
  ziprasidone and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
  
  ziprasidone and deutetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely. The risk for parkinsonism, neuroleptic malignant syndrome, and akathisia may be increased by concomitant use of deutetrabenazine and dopamine antagonists or antipsychotics.

• dexamethasone

  Minor (1)dexamethasone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• dexchlorpheniramine

  Monitor Closely (1)dexchlorpheniramine and ziprasidone both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (1)ziprasidone increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexmedetomidine

  Monitor Closely (1)dexmedetomidine and ziprasidone both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  Monitor Closely (1)ziprasidone increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine

  Monitor Closely (1)ziprasidone increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine transdermal

  Monitor Closely (1)ziprasidone, dextroamphetamine transdermal. Either increases effects of the other by serotonin levels. Modify Therapy/Monitor Closely. Initiate with lower doses and monitor for signs and symptoms of serotonin syndrome, particularly during initiation or dosage increase. If serotonin syndrome occurs, discontinue dextroamphetamine transdermal and concomitant serotonergic drug(s).

• dextromethorphan

  Monitor Closely (1)dextromethorphan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• dextromoramide

  Monitor Closely (1)dextromoramide and ziprasidone both increase sedation. Use Caution/Monitor.

• DHEA, herbal

  Minor (1)DHEA, herbal will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• diamorphine

  Monitor Closely (1)diamorphine and ziprasidone both increase sedation. Use Caution/Monitor.

• diazepam

  Monitor Closely (1)diazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• dichlorphenamide

  Monitor Closely (1)dichlorphenamide and ziprasidone both decrease serum potassium. Use Caution/Monitor.

• dicyclomine

  Monitor Closely (3)dicyclomine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  dicyclomine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of dicyclomine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• diethylpropion

  Monitor Closely (1)ziprasidone increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• difelikefalin

  Monitor Closely (1)difelikefalin and ziprasidone both increase sedation. Use Caution/Monitor.

• difenoxin hcl

  Monitor Closely (1)difenoxin hcl and ziprasidone both increase sedation. Use Caution/Monitor.

• dihydroergotamine

  Monitor Closely (1)dihydroergotamine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• dimenhydrinate

  Monitor Closely (1)dimenhydrinate and ziprasidone both increase sedation. Use Caution/Monitor.

• diphenhydramine

  Monitor Closely (4)diphenhydramine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  diphenhydramine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of diphenhydramine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  diphenhydramine and ziprasidone both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  Monitor Closely (1)diphenoxylate hcl and ziprasidone both increase sedation. Use Caution/Monitor.

• dipipanone

  Monitor Closely (1)dipipanone and ziprasidone both increase sedation. Use Caution/Monitor.

• disopyramide

  Contraindicated (1)disopyramide and ziprasidone both increase QTc interval. Contraindicated.

• dobutamine

  Monitor Closely (1)ziprasidone increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dofetilide

  Serious - Use Alternative (1)dofetilide and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  Monitor Closely (1)dolasetron and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• donepezil

  Serious - Use Alternative (1)donepezil and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• dopamine

  Monitor Closely (1)ziprasidone increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)ziprasidone decreases effects of dopamine by pharmacodynamic antagonism. Contraindicated.

• dopexamine

  Monitor Closely (1)ziprasidone increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dosulepin

  Monitor Closely (1)ziprasidone and dosulepin both increase sedation. Use Caution/Monitor.

• doxepin

  Monitor Closely (1)ziprasidone and doxepin both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)doxepin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• doxylamine

  Monitor Closely (1)doxylamine and ziprasidone both increase sedation. Use Caution/Monitor.

• dronedarone

  Serious - Use Alternative (2)dronedarone and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
  
  dronedarone will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• droperidol

  Monitor Closely (2)droperidol and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  droperidol and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)droperidol and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• efavirenz

  Serious - Use Alternative (1)efavirenz and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)efavirenz will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eletriptan

  Monitor Closely (1)eletriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• eliglustat

  Serious - Use Alternative (1)eliglustat and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• encorafenib

  Serious - Use Alternative (1)encorafenib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.

• entrectinib

  Serious - Use Alternative (1)ziprasidone and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

• ephedrine

  Monitor Closely (1)ziprasidone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  Monitor Closely (1)ziprasidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• epinephrine racemic

  Monitor Closely (1)ziprasidone increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine racemic and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• ergoloid mesylates

  Monitor Closely (1)ergoloid mesylates, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• ergotamine

  Monitor Closely (1)ergotamine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• eribulin

  Serious - Use Alternative (1)eribulin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

• erythromycin base

  Monitor Closely (1)erythromycin base will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin base and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin ethylsuccinate

  Monitor Closely (1)erythromycin ethylsuccinate will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin ethylsuccinate and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin lactobionate

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• erythromycin stearate

  Monitor Closely (1)erythromycin stearate will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin stearate and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• escitalopram

  Contraindicated (2)escitalopram and ziprasidone both increase QTc interval. Contraindicated.
  
  ziprasidone and escitalopram both increase QTc interval. Contraindicated.

• esketamine intranasal

  Monitor Closely (1)esketamine intranasal, ziprasidone. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• eslicarbazepine acetate

  Minor (1)eslicarbazepine acetate will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• estazolam

  Monitor Closely (1)estazolam and ziprasidone both increase sedation. Use Caution/Monitor.

• ethanol

  Monitor Closely (1)ziprasidone and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• etomidate

  Monitor Closely (1)etomidate and ziprasidone both increase sedation. Use Caution/Monitor.

• etravirine

  Minor (1)etravirine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• eucalyptus

  Minor (1)ziprasidone and eucalyptus both increase sedation. Minor/Significance Unknown.

• exenatide injectable solution

  Monitor Closely (1)ziprasidone, exenatide injectable solution. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• exenatide injectable suspension

  Monitor Closely (1)ziprasidone, exenatide injectable suspension. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• ezogabine

  Monitor Closely (1)ezogabine, ziprasidone. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fenfluramine

  Monitor Closely (2)ziprasidone decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.
  
  ziprasidone increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fentanyl

  Monitor Closely (1)fentanyl, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• fesoterodine

  Monitor Closely (3)fesoterodine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  fesoterodine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of fesoterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• fexinidazole

  Serious - Use Alternative (1)fexinidazole and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.

• finerenone

  Monitor Closely (1)ziprasidone will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.

• fingolimod

  Serious - Use Alternative (1)fingolimod and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• flavoxate

  Monitor Closely (3)flavoxate decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  flavoxate decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of flavoxate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• flecainide

  Monitor Closely (1)flecainide and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• flibanserin

  Monitor Closely (2)ziprasidone will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.
  
  flibanserin, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• floxuridine

  Monitor Closely (1)floxuridine and ziprasidone both increase QTc interval. Use Caution/Monitor.

• fluconazole

  Serious - Use Alternative (1)fluconazole and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)fluconazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fludrocortisone

  Minor (1)fludrocortisone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fluoxetine

  Monitor Closely (1)fluoxetine and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• fluphenazine

  Monitor Closely (2)fluphenazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  fluphenazine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)fluphenazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• flurazepam

  Monitor Closely (1)flurazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• fluvoxamine

  Monitor Closely (1)fluvoxamine and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• formoterol

  Monitor Closely (1)ziprasidone increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)formoterol and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• fosamprenavir

  Minor (1)fosamprenavir will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fosaprepitant

  Minor (1)fosaprepitant will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• foscarnet

  Monitor Closely (1)foscarnet and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• fosphenytoin

  Minor (1)fosphenytoin will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• fostemsavir

  Monitor Closely (1)ziprasidone and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• frovatriptan

  Monitor Closely (1)frovatriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• gadobenate

  Serious - Use Alternative (1)gadobenate and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• ganaxolone

  Monitor Closely (1)ziprasidone and ganaxolone both increase sedation. Use Caution/Monitor.

• gemifloxacin

  Serious - Use Alternative (1)gemifloxacin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• gemtuzumab

  Monitor Closely (1)ziprasidone and gemtuzumab both increase QTc interval. Use Caution/Monitor.

• gilteritinib

  Serious - Use Alternative (1)gilteritinib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• glasdegib

  Serious - Use Alternative (1)ziprasidone and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

• glimepiride

  Monitor Closely (1)ziprasidone, glimepiride. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• glipizide

  Monitor Closely (1)ziprasidone, glipizide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• glyburide

  Monitor Closely (1)ziprasidone, glyburide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• glycopyrrolate

  Monitor Closely (1)ziprasidone increases effects of glycopyrrolate by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• glycopyrrolate inhaled

  Monitor Closely (3)glycopyrrolate inhaled decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  glycopyrrolate inhaled decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of glycopyrrolate inhaled by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• goserelin

  Contraindicated (1)goserelin increases toxicity of ziprasidone by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• granisetron

  Serious - Use Alternative (1)granisetron and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• grapefruit

  Minor (1)grapefruit will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• griseofulvin

  Minor (1)griseofulvin will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• guanfacine

  Monitor Closely (1)guanfacine, ziprasidone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects; potential delirium.

• haloperidol

  Monitor Closely (2)haloperidol and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  haloperidol and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)haloperidol and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• henbane

  Monitor Closely (3)henbane decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  henbane decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of henbane by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• histrelin

  Serious - Use Alternative (1)histrelin increases toxicity of ziprasidone by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• homatropine

  Monitor Closely (3)homatropine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  homatropine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of homatropine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• hydrocodone

  Serious - Use Alternative (1)hydrocodone, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• hydrocortisone

  Minor (1)hydrocortisone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• hydromorphone

  Monitor Closely (1)hydromorphone and ziprasidone both increase sedation. Use Caution/Monitor.

• hydroxychloroquine sulfate

  Serious - Use Alternative (1)hydroxychloroquine sulfate and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyzine

  Monitor Closely (1)hydroxyzine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)hydroxyzine increases toxicity of ziprasidone by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• hyoscyamine

  Monitor Closely (3)hyoscyamine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  hyoscyamine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of hyoscyamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• hyoscyamine spray

  Monitor Closely (3)ziprasidone increases effects of hyoscyamine spray by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.
  
  hyoscyamine spray decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  hyoscyamine spray decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.

• ibutilide

  Contraindicated (1)ibutilide and ziprasidone both increase QTc interval. Contraindicated.

• iloperidone

  Monitor Closely (3)iloperidone and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  iloperidone and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  iloperidone and ziprasidone both increase sedation. Use Caution/Monitor.

• imipramine

  Monitor Closely (1)ziprasidone and imipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)imipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• indacaterol, inhaled

  Monitor Closely (1)indacaterol, inhaled, ziprasidone. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indapamide

  Contraindicated (1)indapamide and ziprasidone both increase QTc interval. Contraindicated.

• indinavir

  Minor (1)indinavir will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• inotuzumab

  Serious - Use Alternative (1)inotuzumab and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

• insulin aspart

  Monitor Closely (1)ziprasidone, insulin aspart. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• insulin degludec

  Monitor Closely (1)ziprasidone decreases effects of insulin degludec by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

• insulin degludec/insulin aspart

  Monitor Closely (1)ziprasidone decreases effects of insulin degludec/insulin aspart by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

• insulin detemir

  Monitor Closely (1)ziprasidone, insulin detemir. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• insulin glargine

  Monitor Closely (1)ziprasidone, insulin glargine. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• insulin glulisine

  Monitor Closely (1)ziprasidone, insulin glulisine. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• insulin inhaled

  Monitor Closely (1)ziprasidone decreases effects of insulin inhaled by Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; dose of antidiabetic agents may need adjustment and increased frequency of glucose monitoring may be required.

• insulin lispro

  Monitor Closely (1)ziprasidone, insulin lispro. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• insulin NPH

  Monitor Closely (1)ziprasidone, insulin NPH. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• insulin regular human

  Monitor Closely (1)ziprasidone, insulin regular human. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• ipratropium

  Monitor Closely (3)ipratropium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  ipratropium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of ipratropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• isavuconazonium sulfate

  Monitor Closely (1)ziprasidone will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• isoflurane

  Serious - Use Alternative (1)isoflurane and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• isoniazid

  Minor (1)isoniazid will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• isoproterenol

  Monitor Closely (1)ziprasidone increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• itraconazole

  Monitor Closely (1)itraconazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)itraconazole and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• ivacaftor

  Monitor Closely (1)ziprasidone increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .

• ivosidenib

  Serious - Use Alternative (1)ivosidenib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

• ketoconazole

  Monitor Closely (1)ketoconazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)ketoconazole and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• ketotifen, ophthalmic

  Monitor Closely (1)ziprasidone and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• lapatinib

  Monitor Closely (1)lapatinib and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)lapatinib will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lasmiditan

  Monitor Closely (1)lasmiditan, ziprasidone. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

• lefamulin

  Serious - Use Alternative (1)lefamulin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• lemborexant

  Monitor Closely (2)ziprasidone will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.
  
  lemborexant, ziprasidone. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

• lenvatinib

  Monitor Closely (1)ziprasidone and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

• letermovir

  Monitor Closely (1)letermovir increases levels of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• leuprolide

  Contraindicated (1)leuprolide increases toxicity of ziprasidone by QTc interval. Contraindicated. Increases risk of torsades de pointes.

• levalbuterol

  Monitor Closely (1)ziprasidone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levodopa

  Serious - Use Alternative (1)ziprasidone decreases effects of levodopa by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

• levodopa inhaled

  Serious - Use Alternative (1)ziprasidone decreases effects of levodopa inhaled by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Atypical (2nd generation) antipsychotics inhibit dopamine D2 receptors in varying degrees (clozapine and quetiapine are lower risk). .

• levofloxacin

  Monitor Closely (1)levofloxacin and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• levoketoconazole

  Monitor Closely (1)levoketoconazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)levoketoconazole and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• levomilnacipran

  Monitor Closely (1)levomilnacipran, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• levorphanol

  Monitor Closely (1)levorphanol and ziprasidone both increase sedation. Use Caution/Monitor.

• linezolid

  Monitor Closely (1)linezolid, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• liraglutide

  Monitor Closely (1)ziprasidone, liraglutide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• lisdexamfetamine

  Monitor Closely (1)ziprasidone increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lisuride

  Serious - Use Alternative (1)ziprasidone decreases effects of lisuride by pharmacodynamic antagonism. Contraindicated.

• lithium

  Monitor Closely (1)lithium, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).Serious - Use Alternative (1)lithium and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• lofepramine

  Monitor Closely (1)ziprasidone and lofepramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)lofepramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• lofexidine

  Monitor Closely (2)ziprasidone and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended.
  
  ziprasidone and lofexidine both increase sedation. Use Caution/Monitor.

• lomitapide

  Monitor Closely (1)ziprasidone increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.

• lonafarnib

  Serious - Use Alternative (1)ziprasidone will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.

• loprazolam

  Monitor Closely (1)loprazolam and ziprasidone both increase sedation. Use Caution/Monitor.

• lorazepam

  Monitor Closely (1)lorazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• lorcaserin

  Monitor Closely (1)lorcaserin, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).Serious - Use Alternative (1)ziprasidone and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.

• lormetazepam

  Monitor Closely (1)lormetazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• loxapine

  Monitor Closely (2)loxapine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  loxapine and ziprasidone both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  Monitor Closely (2)loxapine inhaled and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  loxapine inhaled and ziprasidone both increase sedation. Use Caution/Monitor.

• lumefantrine

  Serious - Use Alternative (1)lumefantrine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)lumefantrine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lurasidone

  Monitor Closely (1)lurasidone, ziprasidone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

• macimorelin

  Serious - Use Alternative (1)macimorelin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  Monitor Closely (1)ziprasidone and maprotiline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)maprotiline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• maraviroc

  Monitor Closely (1)maraviroc, ziprasidone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

• marijuana

  Monitor Closely (1)ziprasidone and marijuana both increase sedation. Use Caution/Monitor.Minor (1)marijuana will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• meclizine

  Monitor Closely (3)meclizine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  meclizine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of meclizine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• mefloquine

  Serious - Use Alternative (1)mefloquine increases toxicity of ziprasidone by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

• melatonin

  Monitor Closely (1)ziprasidone and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  Monitor Closely (2)meperidine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
  
  meperidine and ziprasidone both increase sedation. Use Caution/Monitor.

• meprobamate

  Monitor Closely (1)ziprasidone and meprobamate both increase sedation. Use Caution/Monitor.

• metaproterenol

  Monitor Closely (1)ziprasidone increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaxalone

  Monitor Closely (1)metaxalone and ziprasidone both increase sedation. Use Caution/Monitor.

• metformin

  Monitor Closely (1)ziprasidone, metformin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• methadone

  Monitor Closely (3)methadone, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
  
  methadone and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  methadone and ziprasidone both increase sedation. Use Caution/Monitor.

• methamphetamine

  Monitor Closely (1)ziprasidone increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methocarbamol

  Monitor Closely (1)methocarbamol and ziprasidone both increase sedation. Use Caution/Monitor.

• methscopolamine

  Monitor Closely (3)methscopolamine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  methscopolamine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of methscopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• methyldopa

  Serious - Use Alternative (1)ziprasidone decreases effects of methyldopa by pharmacodynamic antagonism. Contraindicated.

• methylenedioxymethamphetamine

  Monitor Closely (1)ziprasidone increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methylergonovine

  Monitor Closely (1)methylergonovine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• methylphenidate

  Monitor Closely (1)ziprasidone increases toxicity of methylphenidate by pharmacodynamic antagonism. Use Caution/Monitor. Closely monitor for signs of altered clinical response to either methylphenidate or an antipsychotic when using these drugs in combination.

• methylprednisolone

  Minor (1)methylprednisolone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• metoclopramide

  Monitor Closely (1)ziprasidone and metoclopramide both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.

• metoclopramide intranasal

  Serious - Use Alternative (2)ziprasidone, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.
  
  ziprasidone increases toxicity of metoclopramide intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive effects, including increased frequency and severity of tardive dyskinesia, other extrapyramidal symptoms, and neuroleptic malignant syndrome.

• metronidazole

  Minor (1)metronidazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• miconazole vaginal

  Minor (1)miconazole vaginal will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• midazolam

  Monitor Closely (1)midazolam and ziprasidone both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  Monitor Closely (1)midazolam intranasal, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  Monitor Closely (1)ziprasidone increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mifepristone

  Monitor Closely (1)mifepristone, ziprasidone. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• miglitol

  Monitor Closely (1)ziprasidone, miglitol. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• milnacipran

  Monitor Closely (1)milnacipran, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• mirtazapine

  Monitor Closely (1)ziprasidone and mirtazapine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)mirtazapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• mobocertinib

  Serious - Use Alternative (1)mobocertinib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• modafinil

  Monitor Closely (1)ziprasidone increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  Monitor Closely (1)morphine and ziprasidone both increase sedation. Use Caution/Monitor.

• motherwort

  Monitor Closely (1)ziprasidone and motherwort both increase sedation. Use Caution/Monitor.

• moxifloxacin

  Serious - Use Alternative (1)moxifloxacin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• moxonidine

  Monitor Closely (1)ziprasidone and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  Monitor Closely (1)ziprasidone and nabilone both increase sedation. Use Caution/Monitor.

• nafcillin

  Minor (1)nafcillin will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nalbuphine

  Monitor Closely (1)nalbuphine and ziprasidone both increase sedation. Use Caution/Monitor.

• naratriptan

  Monitor Closely (1)naratriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• nateglinide

  Monitor Closely (1)ziprasidone, nateglinide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• nefazodone

  Monitor Closely (1)nefazodone will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nelfinavir

  Minor (1)nelfinavir will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nevirapine

  Minor (1)nevirapine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nifedipine

  Minor (1)nifedipine will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• nilotinib

  Serious - Use Alternative (1)nilotinib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)nilotinib will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• norepinephrine

  Monitor Closely (1)ziprasidone increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nortriptyline

  Monitor Closely (1)ziprasidone and nortriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)nortriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide

  Serious - Use Alternative (1)octreotide and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)

  Serious - Use Alternative (1)octreotide (Antidote) and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• ofloxacin

  Monitor Closely (1)ofloxacin and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine

  Monitor Closely (2)olanzapine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  olanzapine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)olanzapine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• oliceridine

  Monitor Closely (1)oliceridine, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• olodaterol inhaled

  Monitor Closely (1)ziprasidone and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• olopatadine intranasal

  Serious - Use Alternative (1)ziprasidone and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• onabotulinumtoxinA

  Monitor Closely (3)onabotulinumtoxinA decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  onabotulinumtoxinA decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• ondansetron

  Serious - Use Alternative (1)ziprasidone and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

• opium tincture

  Monitor Closely (1)opium tincture and ziprasidone both increase sedation. Use Caution/Monitor.

• orphenadrine

  Monitor Closely (1)orphenadrine and ziprasidone both increase sedation. Use Caution/Monitor.

• osilodrostat

  Monitor Closely (1)osilodrostat and ziprasidone both increase QTc interval. Use Caution/Monitor.

• osimertinib

  Monitor Closely (1)osimertinib and ziprasidone both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxaliplatin

  Monitor Closely (1)oxaliplatin will increase the level or effect of ziprasidone by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.Serious - Use Alternative (1)oxaliplatin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• oxazepam

  Monitor Closely (1)oxazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• oxcarbazepine

  Minor (1)oxcarbazepine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• oxybutynin

  Monitor Closely (3)oxybutynin decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  oxybutynin decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of oxybutynin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• oxybutynin topical

  Monitor Closely (3)oxybutynin topical decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  oxybutynin topical decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of oxybutynin topical by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• oxybutynin transdermal

  Monitor Closely (3)oxybutynin transdermal decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  oxybutynin transdermal decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of oxybutynin transdermal by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• oxycodone

  Monitor Closely (1)oxycodone and ziprasidone both increase sedation. Use Caution/Monitor.

• oxymorphone

  Monitor Closely (1)oxymorphone and ziprasidone both increase sedation. Use Caution/Monitor.

• ozanimod

  Monitor Closely (1)ozanimod and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• paliperidone

  Monitor Closely (3)paliperidone and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  paliperidone and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  paliperidone and ziprasidone both increase sedation. Use Caution/Monitor.

• pancuronium

  Monitor Closely (3)pancuronium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  pancuronium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of pancuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• panobinostat

  Serious - Use Alternative (1)ziprasidone and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

• papaveretum

  Monitor Closely (1)papaveretum and ziprasidone both increase sedation. Use Caution/Monitor.

• papaverine

  Monitor Closely (1)ziprasidone and papaverine both increase sedation. Use Caution/Monitor.

• paroxetine

  Monitor Closely (2)paroxetine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
  
  paroxetine and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• pasireotide

  Monitor Closely (1)ziprasidone and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  Monitor Closely (1)pazopanib and ziprasidone both increase QTc interval. Use Caution/Monitor.

• pentamidine

  Contraindicated (1)pentamidine and ziprasidone both increase QTc interval. Contraindicated.

• pentazocine

  Monitor Closely (1)pentazocine and ziprasidone both increase sedation. Use Caution/Monitor.

• pentobarbital

  Monitor Closely (1)pentobarbital and ziprasidone both increase sedation. Use Caution/Monitor.Minor (1)pentobarbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• perphenazine

  Monitor Closely (2)perphenazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  perphenazine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)perphenazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• phendimetrazine

  Monitor Closely (1)ziprasidone increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenelzine

  Monitor Closely (1)phenelzine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• phenobarbital

  Monitor Closely (1)phenobarbital and ziprasidone both increase sedation. Use Caution/Monitor.Minor (1)phenobarbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• phentermine

  Monitor Closely (1)ziprasidone increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine

  Monitor Closely (1)ziprasidone increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine PO

  Monitor Closely (1)ziprasidone increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• phenytoin

  Minor (1)phenytoin will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• pholcodine

  Monitor Closely (1)ziprasidone and pholcodine both increase sedation. Use Caution/Monitor.

• pimavanserin

  Serious - Use Alternative (1)pimavanserin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.

• pimozide

  Contraindicated (1)pimozide and ziprasidone both increase QTc interval. Contraindicated.Monitor Closely (2)pimozide and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  pimozide and ziprasidone both increase sedation. Use Caution/Monitor.

• pioglitazone

  Monitor Closely (1)ziprasidone, pioglitazone. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• pirbuterol

  Monitor Closely (1)ziprasidone increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pitolisant

  Serious - Use Alternative (1)ziprasidone and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• ponesimod

  Serious - Use Alternative (1)ponesimod, ziprasidone. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Generally, should not be initiated in patients who are concurrently taking QT prolonging drugs with known arrhythmogenic properties, such as HR-lowering calcium channel blockers (eg, verapamil, diltiazem).

• posaconazole

  Monitor Closely (1)posaconazole and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)posaconazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• pralidoxime

  Monitor Closely (3)pralidoxime decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  pralidoxime decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of pralidoxime by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• pramipexole

  Serious - Use Alternative (1)ziprasidone decreases effects of pramipexole by pharmacodynamic antagonism. Contraindicated.

• pramlintide

  Monitor Closely (1)ziprasidone, pramlintide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• prednisone

  Minor (1)prednisone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• primaquine

  Serious - Use Alternative (1)primaquine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• primidone

  Monitor Closely (1)primidone and ziprasidone both increase sedation. Use Caution/Monitor.Minor (1)primidone will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• procainamide

  Contraindicated (1)procainamide and ziprasidone both increase QTc interval. Contraindicated.

• procarbazine

  Monitor Closely (1)procarbazine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• prochlorperazine

  Monitor Closely (2)prochlorperazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  prochlorperazine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)prochlorperazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• promazine

  Serious - Use Alternative (1)promazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• promethazine

  Monitor Closely (3)promethazine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
  
  promethazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  promethazine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)promethazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• propantheline

  Monitor Closely (3)propantheline decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  propantheline decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of propantheline by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• propofol

  Monitor Closely (1)propofol and ziprasidone both increase sedation. Use Caution/Monitor.

• propylhexedrine

  Monitor Closely (1)ziprasidone increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protriptyline

  Monitor Closely (1)ziprasidone and protriptyline both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)protriptyline and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• quazepam

  Monitor Closely (1)quazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• quetiapine

  Monitor Closely (3)quetiapine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  quetiapine and ziprasidone both increase sedation. Use Caution/Monitor.
  
  quetiapine, ziprasidone. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinidine

  Contraindicated (1)quinidine and ziprasidone both increase QTc interval. Contraindicated.

• quinine

  Monitor Closely (1)ziprasidone and quinine both increase QTc interval. Use Caution/Monitor.

• quinupristin/dalfopristin

  Minor (1)quinupristin/dalfopristin will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ramelteon

  Monitor Closely (1)ziprasidone and ramelteon both increase sedation. Use Caution/Monitor.

• ranolazine

  Monitor Closely (1)ranolazine and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• rapacuronium

  Monitor Closely (3)rapacuronium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  rapacuronium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of rapacuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• remimazolam

  Monitor Closely (1)remimazolam, ziprasidone. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

• repaglinide

  Monitor Closely (1)ziprasidone, repaglinide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• ribociclib

  Serious - Use Alternative (1)ribociclib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  Monitor Closely (1)rifabutin will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifampin

  Monitor Closely (1)rifampin will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifapentine

  Minor (1)rifapentine will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• rilpivirine

  Monitor Closely (1)rilpivirine increases toxicity of ziprasidone by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.

• risperidone

  Monitor Closely (3)risperidone and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  risperidone and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  risperidone and ziprasidone both increase sedation. Use Caution/Monitor.

• ritonavir

  Minor (1)ritonavir will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• rocuronium

  Monitor Closely (3)rocuronium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  rocuronium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of rocuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• romidepsin

  Monitor Closely (1)romidepsin and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely. Avoid using ziprasidone with other QTc prolonging agents.

• ropinirole

  Serious - Use Alternative (1)ziprasidone decreases effects of ropinirole by pharmacodynamic antagonism. Contraindicated.

• rosiglitazone

  Monitor Closely (1)ziprasidone, rosiglitazone. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• rufinamide

  Minor (1)rufinamide will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib

  Minor (1)ziprasidone will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ruxolitinib topical

  Minor (1)ziprasidone will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• safinamide

  Serious - Use Alternative (1)ziprasidone decreases effects of safinamide by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Dopamine antagonists may decrease safinamide effects and exacerbate Parkinson disease symptoms.

• sage

  Minor (1)ziprasidone and sage both increase sedation. Minor/Significance Unknown.

• salmeterol

  Monitor Closely (1)ziprasidone increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• saquinavir

  Contraindicated (1)ziprasidone increases toxicity of saquinavir by QTc interval. Contraindicated. Potential for serious and/or life threatening reactions such as cardiac arrhythmias.

• saxagliptin

  Monitor Closely (1)ziprasidone, saxagliptin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• scopolamine

  Monitor Closely (3)scopolamine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  scopolamine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of scopolamine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• scullcap

  Monitor Closely (1)ziprasidone and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  Monitor Closely (1)secobarbital and ziprasidone both increase sedation. Use Caution/Monitor.Minor (1)secobarbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• selegiline

  Monitor Closely (1)selegiline, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• selinexor

  Serious - Use Alternative (1)selinexor, ziprasidone. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

• selpercatinib

  Monitor Closely (1)selpercatinib increases toxicity of ziprasidone by QTc interval. Use Caution/Monitor.

• sertraline

  Monitor Closely (1)sertraline and ziprasidone both decrease QTc interval. Modify Therapy/Monitor Closely.

• sevoflurane

  Serious - Use Alternative (1)sevoflurane and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• shepherd's purse

  Monitor Closely (1)ziprasidone and shepherd's purse both increase sedation. Use Caution/Monitor.

• siponimod

  Serious - Use Alternative (1)siponimod and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• sitagliptin

  Monitor Closely (1)ziprasidone, sitagliptin. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• sodium oxybate

  Serious - Use Alternative (1)ziprasidone, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (2)sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of ziprasidone by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
  
  sodium sulfate/?magnesium sulfate/potassium chloride increases effects of ziprasidone by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (2)sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of ziprasidone by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
  
  sodium sulfate/potassium sulfate/magnesium sulfate increases effects of ziprasidone by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

• solifenacin

  Monitor Closely (3)solifenacin decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  solifenacin decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of solifenacin by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.Serious - Use Alternative (1)solifenacin and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• sorafenib

  Contraindicated (1)sorafenib and ziprasidone both increase QTc interval. Contraindicated.

• sotalol

  Contraindicated (1)sotalol and ziprasidone both increase QTc interval. Contraindicated.

• St John's Wort

  Monitor Closely (1)St John's Wort will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• stiripentol

  Monitor Closely (1)stiripentol, ziprasidone. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• sufentanil

  Monitor Closely (1)sufentanil and ziprasidone both increase sedation. Use Caution/Monitor.

• sufentanil SL

  Serious - Use Alternative (1)sufentanil SL, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• sulfamethoxazole

  Monitor Closely (1)sulfamethoxazole and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• sumatriptan

  Monitor Closely (1)sumatriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• sumatriptan intranasal

  Monitor Closely (1)sumatriptan intranasal, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• sunitinib

  Serious - Use Alternative (1)sunitinib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• tacrolimus

  Serious - Use Alternative (1)tacrolimus and ziprasidone both increase QTc interval. Contraindicated.

• tapentadol

  Monitor Closely (1)tapentadol and ziprasidone both increase sedation. Use Caution/Monitor.

• tazemetostat

  Monitor Closely (1)ziprasidone will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• telavancin

  Monitor Closely (1)telavancin and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• temazepam

  Monitor Closely (1)temazepam and ziprasidone both increase sedation. Use Caution/Monitor.

• terbutaline

  Monitor Closely (1)ziprasidone increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• tetrabenazine

  Monitor Closely (1)ziprasidone and tetrabenazine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)tetrabenazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• thioridazine

  Monitor Closely (2)thioridazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  thioridazine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)thioridazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• thiothixene

  Monitor Closely (2)thiothixene and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  thiothixene and ziprasidone both increase sedation. Use Caution/Monitor.

• tinidazole

  Monitor Closely (1)ziprasidone will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tiotropium

  Monitor Closely (3)tiotropium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  tiotropium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of tiotropium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• tolazamide

  Monitor Closely (1)ziprasidone, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• tolbutamide

  Monitor Closely (1)ziprasidone, tolbutamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

• tolterodine

  Monitor Closely (3)tolterodine decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  tolterodine decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of tolterodine by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• topiramate

  Monitor Closely (1)ziprasidone and topiramate both increase sedation. Modify Therapy/Monitor Closely.Minor (1)topiramate will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• toremifene

  Contraindicated (1)ziprasidone and toremifene both increase QTc interval. Contraindicated. Concurrent use of ziprasidone with other agents that prolong QTc interval is contraindicated.

• tramadol

  Monitor Closely (1)tramadol and ziprasidone both increase sedation. Use Caution/Monitor.

• tranylcypromine

  Monitor Closely (1)tranylcypromine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• trazodone

  Monitor Closely (1)ziprasidone and trazodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trazodone and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• triazolam

  Monitor Closely (1)triazolam and ziprasidone both increase sedation. Use Caution/Monitor.

• triclabendazole

  Monitor Closely (1)triclabendazole and ziprasidone both increase QTc interval. Use Caution/Monitor.

• triclofos

  Monitor Closely (1)triclofos and ziprasidone both increase sedation. Use Caution/Monitor.

• trifluoperazine

  Monitor Closely (2)trifluoperazine and ziprasidone both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  trifluoperazine and ziprasidone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trifluoperazine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• trimethoprim

  Monitor Closely (1)trimethoprim and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• trimipramine

  Monitor Closely (1)ziprasidone and trimipramine both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• triprolidine

  Monitor Closely (1)triprolidine and ziprasidone both increase sedation. Use Caution/Monitor.

• triptorelin

  Serious - Use Alternative (1)triptorelin increases toxicity of ziprasidone by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.

• tropisetron

  Monitor Closely (1)tropisetron and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• trospium chloride

  Monitor Closely (3)trospium chloride decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  trospium chloride decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of trospium chloride by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• umeclidinium bromide/vilanterol inhaled

  Serious - Use Alternative (1)ziprasidone increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vandetanib

  Serious - Use Alternative (1)ziprasidone, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vecuronium

  Monitor Closely (3)vecuronium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  vecuronium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor.
  
  ziprasidone increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.

• vemurafenib

  Serious - Use Alternative (1)vemurafenib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

• venlafaxine

  Monitor Closely (2)venlafaxine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).
  
  venlafaxine and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

• verapamil

  Minor (1)verapamil will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• vilanterol/fluticasone furoate inhaled

  Serious - Use Alternative (1)ziprasidone increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  Monitor Closely (1)vilazodone, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• voclosporin

  Monitor Closely (1)voclosporin, ziprasidone. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  Monitor Closely (1)voriconazole and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)voriconazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• vorinostat

  Serious - Use Alternative (1)vorinostat and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• xylometazoline

  Monitor Closely (1)ziprasidone increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• yohimbine

  Monitor Closely (1)ziprasidone increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• zafirlukast

  Minor (1)zafirlukast will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ziconotide

  Monitor Closely (1)ziprasidone and ziconotide both increase sedation. Use Caution/Monitor.

• zolmitriptan

  Monitor Closely (1)zolmitriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).

• zotepine

  Monitor Closely (2)ziprasidone and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor.
  
  ziprasidone and zotepine both increase sedation. Use Caution/Monitor.