Ziprasidone

Ziprasidone is an atypical antipsychotic which is used to stabilize the mood of persons suffering from acute and agitated mental health conditions such as schizophrenia, acute mania, and the mixed states often associated with expressions of bipolar disorder.

Overview

Ziprasidone has been used for some years to treat and manage the symptoms of psychotic disorders, in particular schizophrenia, mania, or bipolar disorder. It has been approved by the U.S. Food and Drug Administration (FDA) since 2001 for the treatment of these conditions, but may also be prescribed for less agitated conditions, such as depression.

As an antipsychotic, it works by changing some of the chemicals in the brain (called neurotransmitters) which, when there is too much or too little of these chemicals, can cause periods of psychotic disorders. Although it is not known exactly how these types of drugs act on the brain, it is understood that they block communication between different parts of the brain structure and affect behavior accordingly.

Ziprasidone in particular blocks receptors on the nerves for several neurotransmitters, such as dopamine and serotonin. It also stops the amount of serotonin and norepinephrine that is reabsorbed by the patient’s brain. It is thought that this kind of action allows excess or insufficient amount of these chemicals to stabilize by disrupting abnormal processes. It may be particularly suitable for some people as it is unusual among anti-psychotic drugs for not increasing cholesterol levels or causing weight gain.

Testing in clinical trials has shown that the drug has a mild-standard effectiveness and performs as well, or better, than a number of other common medications for acute mental health conditions. The drug may be delivered either intramuscularly (as an injection) or in an oral form (as capsules.) The injection route is most commonly used for persons suffering from acute agitation brought on by schizophrenia.

Ziprasidone via the intramuscular route is usually used for the acute control and short-term management of the persons in an agitated state and exhibiting signs of psychosis. If it proves an effective treatment for the patient, they may transition to oral ziprasidone in order to keep their mood stable.

There are a number of potentially serious side effects connected to the use of this medication, including muscle disorder and dizziness.

Condition(s) treated?

  • Schizophrenia, bipolar disorder

Type of medicine?

  • Atypical antipsychotic (l)

Side Effects

Ziprasidone is known to have a wide range of side effects, warnings, and contraindications - from minor physical reactions to potentially serious complications. Some of these problems are more common than others. Headaches are the most commonly reported side effect among users. Other common minor side effects include feeling unusually tired (reported by one in seven patients) and some amount of nausea (reported by one in 10 users). If you experience any of the following for extended periods of time while taking the medication, inform your doctor:

  • pervasive headaches
  • periods of fatigue
  • the anxiety and restlessness often associated with anti-psychotic medications.

Some patients may also experience physiological reactions to this medication. This may include problems with bowel movements (either constipation or diarrhea) which were reported by one in 11 users, or restlessness and anxiety (which was reported by one in 12 users.) Some users have reported experiencing a decreased sex drive, weight gain, muscle pain, not feeling hungry and a persistent loss of appetite.

Women say they have also found the drug leaves them with swollen breasts and irregular or missing periods. The last of the groups of symptoms often reported include a runny nose, unexpected weight gain and episodes of dizziness (reported by one in 12 users) and struggling to keep your balance. This can cause additional injuries if the patient falls and injures themselves.

Clinical trials have also shown that there are a number of groups within the population for whom Ziprasidone is particularly contraindicated. These include those with an existing diagnosis of diabetes, pregnant women or older persons suffering from dementia. Anyone with a history of heart problems should also only be given a prescription after careful consideration by their health professional.

Dosage

Using the correct dosage is vital for any medication to be effective. This means that prescription holders must be very careful to ensure they take the right amount of drug at the right time.

It may take several weeks to see the effect of starting to take Ziprasidone. During this period, or at any time during the prescribed period, you should not attempt to change or adjust your dose. This could have dangerous effects on you or your behavior and stop the drug working properly.

The exact dosage of Ziprasidone required depends on whether it is taken orally or by injection, the condition is being prescribed for and the current health of the person it is prescribed to. When the drug is taken via an injection the body can absorb it more effectively, and a smaller dose is required. When it is taken via capsule then more will be excreted from the body as part of normal waste products.

Ziprasidone is available for prescription in capsule form at either 20mg, 40mg, 60mg or 80mg doses. These should be taken with food and should not be chewed or broken before being swallowed. Missing doses may have an adverse effect on whether the drug works properly and should be avoided.

The injected form comes as a 20mg powder dose and it is recommended that no more than 40mg should be used over a single 12-hour period. No studies have been completed on whether this method is efficient beyond three days of administration. After this period, the patient may instead transition to oral ziprasidone in the form of capsules.

The exact dose required will depend on the condition it is being administered for and the current state of the patient. If it is being used for the treatment of schizophrenia then the recommendation is 20 mg taken with food which may be increased until the desired effect is reached. No more than 80 mg should be taken in a 12-hour period.

If the person prescribed this medication is also acutely agitated, and possibly showing psychotic symptoms, then the dosage may change. In that situation 10 mg every two hours is recommended, or 20 mg every four hours.

In order to establish the appropriate dose, medical staff should be looking to find the dosage used at the point at which the patient becomes stable, then use this same amount for maintenance and to maintain a stable mood. Ziprasidone may be given alongside lithium or valproate if the patient’s doctor feels it may be useful.

As with all prescriptions for medications the patient’s needs should be reviewed regularly to establish if the correct dosages or combinations are being given. This should be particularly carefully monitored due to the drug’s significant side effects for some groups of the population.

There are no established doses for children as there is no evidence that the medication is safe and efficient for this group.

Interactions

There are some drugs that cannot be taken in combination with others. These are known as contraindications and can make the prescription less effective, there may be unexpected or unpleasant side effects, or the drug may become more potent in its impact. Some drug interactions can even be harmful to you and, at worst, cause accidental death or long-term conditions.

This means it may be critical to your health to read the label every time you use a non-prescription or prescription drug and you must take the time to learn about drug interactions. By being open and clear with the health professionals looking after you can help reduce the risk of any potential harm to you.

The most important information to share with the doctor prescribing your medication is whether you have any other drugs that you take regularly. This is so they can keep you safe and take precautions as necessary. There are some occasions where it is therapeutic to mix these drugs but the dosages may be adjusted to keep them within safe ranges.

Clinical trials have shown there are a large number of medications which Ziprasidone may interact with. These include:

  • Alfentanil
  • Almotriptan
  • Amineptine
  • Amitriptylinoxide
  • Amoxapine
  • Brompheniramine
  • Buprenorphine
  • Buspirone
  • Butorphanol
  • Carbamazepine
  • Ceritinib
  • Chlorpheniramine
  • Cocaine
  • Codeine
  • Conivaptan
  • Desvenlafaxine
  • Dextromethorphan
  • Dibenzepin
  • Dihydrocodeine
  • Duloxetine
  • Eletriptan
  • Fentanyl
  • Fluvoxamine
  • Frovatriptan
  • Furazolidone
  • Hydrocodone
  • Hydromorphone
  • Hydroxytryptophan
  • Idelalisib
  • Iproniazid
  • Isocarboxazid
  • Levomilnacipran
  • Linezolid
  • Lithium
  • Lofepramine
  • Lorcaserin
  • Melitracen
  • Meperidine
  • Methylene Blue
  • Mifepristone
  • Milnacipran
  • Mirtazapine
  • Moclobemide
  • Morphine
  • Morphine Sulfate Liposome
  • Naratriptan
  • Nefazodone
  • Nialamide
  • Nortriptylin
  • Oxycodone
  • Oxymorphone
  • Pentazocine
  • Procarbazine
  • Remifentanil
  • Rizatriptan
  • Safinamide
  • Selegiline
  • Sertraline
  • Sibutramine
  • St John's Wort
  • Sufentanil
  • Sumatriptan
  • Tianeptine
  • Tramadol
  • Tranylcypromine
  • Vilazodone
  • Vortioxetine
  • Zolmitriptan

Warnings

Ziprasidone has a black box warning after a number of tests found groups and parts of the body that may be adversely affected by using the drug. This is a combination of situations where it may aggravate an existing condition or produce unpleasant side effects.

The following groups and persons, and their health care professionals, should take care when prescribing Ziprasidone (either capsules or intramuscularly) to the following groups:

  • People with heart conditions or weaknesses: one side effect of this drug is that it may change the way the electrical current in your heart works. It’s not a huge change but there were concerns that it may cause dangerous heart rhythm abnormalities in very rare cases. This has not been proven for Ziprasidone but is a noted side effect for other drugs in the same group so heart palpitations or unusual sensations should be reported to your doctor.
  • People taking Ziprasidone may become very sensitive to temperature, either very high or very low. This means that people taking this drug on prescription need to try not to become overheated or dehydrated and should make an effort to drink at least the minimum recommended amount of water per day. Other non-caffeine based drinks can also help in maintaining a person’s hydration level.
  • If you have a Ziprasidone prescription, then you may find it difficult to react to situations as you otherwise would do as the drug may affect your thinking process. This means people are advised not to drive or operate machinery until you know if you suffer from these reactions. It may also cause periods of dizziness when you stand up quickly. Alcohol should absolutely be avoided due to the risk of dangerous side effects.
  • Ziprasidone has not been tested for use in children and its efficacy has not been established for this group.
  • This medicine should not be used to treat behavioral problems in older adults with dementia. It’s not licensed for this group as studies have shown that elderly persons who suffer from a diagnosis of dementia, who also have an existing prescription for antipsychotics such as ziprasidone, have an increased risk of death during the course of their treatment. Older adults with dementia may also have a greater chance of having a stroke or mini-stroke during treatment with this type of medication.
  • Pregnant women are currently not advised to take this drug. That’s because studies completed in animals have shown there may be an adverse effect on humans when using Ziprasidone. This means there have been no clinical trials of this drug upon pregnant women and, as such, no information on side effects.
  • In the same way, there has been no testing on the risk to infants when mothers that are breastfeeding use this medication. As such, it is not currently recommended for this group.
  • This type of medication can leave users with a low blood count, which in turn, may increase the risk of suffering an infection. If you are taking this as a prescription then talk to your doctor if you have signs of an infection. This could a temperature, chills or a sore throat.
  • This medicine increases the risk of developing a condition known as tardive dyskinesia, with an increased risk among older persons and those suffering from diabetes. This risk increases the longer you take it. Call your doctor if you find you struggle to control body movements or have muscle problems in your face.
  • Men should also be aware of this risk of complications where they experience an erect penis for over four hours. This can be damaging to the systems in this area and can cause long-term damage if not quickly treated.

Thanks to these concerns there are a number of clinical or chronic conditions which people may suffer from that will make them unsuitable for Ziprasidone. These include:

  • Persons with blood or bone marrow problems. This could be conditions such as agranulocytosis, leukopenia or neutropenia.
  • Patients that have pre-existing diabetes or hyperglycemia (or high blood sugar). Patients taking this medication may also need to monitor their blood sugar levels more closely.
  • A diagnosis of hyperprolactinemia (high prolactin in the blood)
  • A history of neuroleptic malignant syndrome (NMS)
  • Priapism, or prolonged swelling, in the penis
  • A history of seizures (this is important as the drug may make them worse)
  • If you have a history of Bradycardia (or slow heartbeat)
  • Hypokalemia (low potassium in the blood) or
  • Hypomagnesemia (low magnesium in the blood) or
  • Hypotension (low blood pressure) or
  • Hypovolemia (low amount of blood) or
  • Any history of stroke or transient ischaemic attacks
  • Any problems with swallowing

Because of these contraindications for this medication you must tell your doctor if any of the above conditions, or:

  • If you know that you are allergic to any drugs. You need to mention of a prescription has ever brought you up in a rash, caused itching, shortness of breath or made you feel unwell in any way.
  • If you have ever had an abnormal ECG reading
  • If you have ever suffered from heart problems, or had a heart attack
  • If you know you have low potassium or magnesium levels.

Storage

Ziprasidone does not need to be refrigerated and can be safely stored at a controlled room temperature of between 59° and 86°F. It should be kept away from heat or moisture and stored away from the reach of children. It cannot be frozen.

As with all prescribed drugs, it is not appropriate to throw this medication away if it expires before being taken. Instead you should consult your health professional for advice on safe disposal.

Summary

Ziprasidone is designed to help regulate the levels of chemicals in the brain that may affect, or cause, periods of anxiety, mania or agitation. Clinical trials and patient experience have proven it is a useful drug in the treatment of psychotic disorders and manias. However, it needs to be carefully prescribed due to its significant list of side effects.

These can include aggravating the condition of persons with diabetes or existing heart conditions. It can slow down the patient’s reaction times and should not be given without the person taking precautions when driving or using machinery. Elevated temperature and dehydration may also create increased risks when taking this drug.

In addition, there are significant risks of this medication interacting badly with a wide range of other drugs – some of which may be prescribed for other conditions. As such it’s very important for the patient to disclose to their doctor the full extent of their drugs regime before starting to take Ziprasidone in either its capsule of injection form.

Medics should also ensure they take a full and complete medical history to identify any pre-existing conditions that may cause dangerous interactions in the same way. For all of these reasons, regular medication reviews by a health professional are also important as the patient’s condition develops.

When used appropriately and effectively Ziprasidone can be a useful tool in a drug combination that supports good mental health among persons with a history of psychosis. It also avoids significant side effects of other anti-psychotics, such as high cholesterol.

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Last Reviewed:
December 25, 2017
Last Updated:
December 22, 2017
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