What are the potential side effects of ziprasidone (Geodon) and how are they managed?

From the Guidelines

Ziprasidone (Geodon) can cause several side effects, including QT interval prolongation, extrapyramidal symptoms, and metabolic effects, which require careful management to minimize morbidity, mortality, and improve quality of life. According to a class II study by Harrigan et al 1, ziprasidone, like other antipsychotics, can prolong the QTc interval, with a mean increase of 1.7 ms to 30.1 ms, although none exceeded 500 ms. Common side effects include drowsiness, dizziness, restlessness, nausea, constipation, and weight gain (though less than other antipsychotics) 1. More serious concerns include QT interval prolongation, which increases the risk of dangerous heart rhythm abnormalities, especially when combined with other medications that affect heart rhythm. Extrapyramidal symptoms like muscle stiffness, tremors, and akathisia may occur, as can metabolic effects including elevated blood sugar and lipid levels.

Management strategies include:

• Taking ziprasidone with food (which doubles absorption)
• Starting at low doses and gradually increasing
• Regular monitoring of heart rhythm via ECG (especially in patients with cardiac risk factors)
• Blood glucose and lipid testing
• Symptom monitoring
• For extrapyramidal symptoms, dose adjustments or anticholinergic medications may help
• Ziprasidone should be avoided in patients with significant heart conditions or when taking other medications that prolong QT interval, as supported by a study by Brook et al 1, which found that ziprasidone was associated with a lower incidence of movement disorders compared to haloperidol.

The medication works by blocking dopamine and serotonin receptors in the brain, which helps control psychotic symptoms but also explains many of its side effects. Patients should never stop taking ziprasidone abruptly as this can cause withdrawal symptoms or symptom recurrence, highlighting the importance of careful management and monitoring to minimize risks and improve outcomes 1.

From the FDA Drug Label

Possible Side Effects Because these problems could mean you're having a heart rhythm abnormality, contact your doctor IMMEDIATELYif you: Faint or lose consciousness Feel a change in the way that your heart beats (palpitations) Common side effects of ziprasidone capsules include the following and should also be discussed with your doctor if they occur: Adults: Feeling unusually tired or sleepy Nausea or upset stomach Constipation Dizziness Restlessness Abnormal muscle movements, including tremor, shuffling, and uncontrolled involuntary movements Diarrhea Rash Increased cough / runny nose

A serious condition called neuroleptic malignant syndrome (NMS) can occur with all antipsychotic medications including ziprasidone capsules Signs of NMS include very high fever, rigid muscles, shaking, confusion, sweating, or increased heart rate and blood pressure. Delayed-onset drug reaction called drug reaction with eosinophilia and systemic symptoms (DRESS) can occur with ziprasidone. Signs of DRESS may include rash, fever, and swollen lymph nodes. Other severe cutaneous adverse reactions (SCAR), such as Stevens-Johnson syndrome can occur with ziprasidone. Signs of Stevens-Johnson syndrome may include rash with blisters which could include ulcers in mouth, skin shedding, fever and target-like spots in the skin

Adverse reactions related to high blood sugar (hyperglycemia), sometimes serious, have been reported in patients treated with atypical antipsychotics

Dizziness caused by a drop in your blood pressure may occur with ziprasidone capsules, especially when you first start taking this medication or when the dose is increased.

The potential side effects of ziprasidone (Geodon) include:

• Heart rhythm abnormalities, such as fainting or palpitations
• Common side effects, such as:

• Feeling unusually tired or sleepy
• Nausea or upset stomach
• Constipation
• Dizziness
• Restlessness
• Abnormal muscle movements
• Diarrhea
• Rash
• Increased cough / runny nose

• Serious conditions, such as:

• Neuroleptic malignant syndrome (NMS)
• Drug reaction with eosinophilia and systemic symptoms (DRESS)
• Severe cutaneous adverse reactions (SCAR), such as Stevens-Johnson syndrome
• Hyperglycemia

• Other side effects, such as dizziness caused by a drop in blood pressure 2 Additionally, other potential side effects include:
• Seizures, which occurred in 0.4% of patients treated with ziprasidone 2
• Dysphagia, esophageal dysmotility and aspiration, which have been associated with antipsychotic drug use 2
• Hyperprolactinemia, which can lead to galactorrhea, amenorrhea, gynecomastia, and impotence 2
• Potential for cognitive and motor impairment, including somnolence, which was reported in 14% of patients on ziprasidone 2
• Priapism, which has been reported with other drugs with alpha-adrenergic blocking effects 2
• Body temperature regulation, as antipsychotic agents have been reported to disrupt the body's ability to reduce core body temperature 2
• Suicide, as the possibility of a suicide attempt is inherent in psychotic illness or bipolar disorder 2

From the Research

Potential Side Effects of Ziprasidone (Geodon)

• Somnolence (sleepiness) is a common side effect of ziprasidone, as reported in several studies 3, 4, 5
• Ziprasidone may cause QT interval prolongation, which can increase the risk of cardiac arrhythmias, although this risk is considered relatively low 6, 4, 5
• Extrapyramidal side effects (such as tremors, rigidity, and bradykinesia) are less common with ziprasidone compared to other antipsychotics, but can still occur 3, 4, 5
• Ziprasidone is not typically associated with significant weight gain, changes in cholesterol or triglyceride levels, or adverse effects on glycemic control 3, 6, 4
• Other potential side effects of ziprasidone include dizziness, anxiety, agitation, and insomnia 5

Management of Side Effects

• To minimize the risk of QT interval prolongation, ziprasidone should be avoided in patients with certain cardiac conditions or uncontrolled electrolyte disturbances 6
• Patients taking ziprasidone should be monitored for signs of somnolence, extrapyramidal side effects, and other potential side effects 3, 4, 5
• Dose adjustments or switching to a different medication may be necessary if side effects are severe or persistent 3, 4
• Ziprasidone should be administered with a 500 kcal meal to enhance absorption and minimize the risk of side effects 3