Is there a parenteral form of Geodon (ziprasidone)?

Parenteral Ziprasidone (Geodon) Availability

Yes, ziprasidone (Geodon) is available in an intramuscular (IM) injectable form, with a concentration of 20 mg/mL when reconstituted according to label instructions. 1

Details of Parenteral Ziprasidone

The intramuscular formulation of ziprasidone has the following characteristics:

• Formulation: Available as ziprasidone mesylate for injection in a single-dose vial 1
• Concentration: 20 mg ziprasidone per mL when reconstituted 1
• Composition: Each mL contains 20 mg of ziprasidone and 4.7 mg of methanesulfonic acid solubilized by 294 mg of sulfobutylether β-cyclodextrin sodium (SBECD) 1
• Administration route: For intramuscular use only 1

Clinical Applications of IM Ziprasidone

The intramuscular formulation of ziprasidone is FDA-approved for:

• Treatment of acute agitation in patients with schizophrenia 2, 3
• Rapid control of agitation in psychiatric emergencies 4

Efficacy of IM Ziprasidone

• Produces significant and rapid reduction in agitation within 15-30 minutes of administration 3
• Clinical trials have demonstrated that ziprasidone IM 20 mg decreases agitation scores quickly and effectively 4
• Shows efficacy equal to or greater than conventional therapy (usually haloperidol with lorazepam) 4
• Significantly decreases mean restraint time compared to historic controls 4
• Maintains effectiveness during transition from IM to oral formulation 3

Advantages of IM Ziprasidone

• Lower incidence of extrapyramidal symptoms compared to conventional antipsychotics 2, 3
• Notably low incidence of movement disorders, including dystonia and hypertonia 4
• Can be administered with benzodiazepines without adverse consequences in clinical trials 3
• First atypical antipsychotic available in both IM and oral formulations, allowing for seamless transition to maintenance therapy 5

Safety Considerations

• QTc interval prolongation: Ziprasidone can cause modest QTc interval prolongation comparable to haloperidol IM 3
• Most common adverse events associated with ziprasidone IM include insomnia, headache, and dizziness 3
• No consistent pattern of increasing adverse events with escalating doses has been observed 3

Clinical Pearls

• The 20 mg dose is more effective than the 10 mg dose, though both are significantly better than a 2 mg dose 4
• When transitioning from IM to oral ziprasidone, symptom control can be maintained with appropriate dosing 3
• Ziprasidone IM has shown efficacy in real-world settings with patients experiencing extreme agitation, including those with recent history of alcohol or substance abuse 3

For acute agitation in psychiatric emergencies, ziprasidone IM offers an effective option with a favorable side effect profile compared to conventional antipsychotics, particularly for patients who may later transition to oral ziprasidone therapy.