Overview of Ziprasidone (Geodon)
Ziprasidone is an atypical (second-generation) antipsychotic medication with the following FDA-approved indications:
- Oral ziprasidone (ziprasidone hydrochloride): Treatment of schizophrenia and acute manic or mixed episodes associated with bipolar disorder 3
- Intramuscular ziprasidone (ziprasidone mesylate): Control of acute agitation in patients with schizophrenia 1
Formulations and Administration
- Available as Geodon capsules for oral administration 2
- Initial oral dosing typically starts at 20 mg twice daily with food 4
- Dose range of 40-80 mg twice daily for acute illness phases 1
- Maintenance dosing of 20-80 mg twice daily for chronic schizophrenia or schizoaffective disorder 1
- Taking ziprasidone with food is essential for proper absorption and efficacy 4
Clinical Considerations
Advantages of Ziprasidone (Geodon)
- Weight neutral profile - does not cause clinically significant weight gain 4, 3
- No adverse changes in cholesterol, triglycerides, or glycemic control 4, 3
- Low propensity for extrapyramidal side effects 4, 3
- No significant persistent effects on prolactin levels 3
- Not anticholinergic 3
- Available in both oral and intramuscular formulations, allowing for transition from acute to maintenance therapy 1
Important Precautions
- QT interval prolongation: Ziprasidone has a greater capacity to prolong the QT/QTc interval compared to several other antipsychotics 4
- ECG monitoring is recommended at baseline and periodically during treatment 4
- Contraindicated in elderly patients with dementia-related psychosis due to increased mortality risk 4
- May cause somnolence as a side effect 3
Unique Pharmacological Profile
Ziprasidone has a distinctive receptor binding profile that includes:
- 5-HT2A/D2 antagonism (shared with other atypical antipsychotics) 5
- 5-HT1A receptor agonist activity 6
- Antagonism at 5-HT2C and 5-HT1B/1D receptors 6
- Weak inhibition of serotonin and norepinephrine reuptake 5, 6
This unique pharmacological profile contributes to its efficacy against positive, negative, and affective symptoms of schizophrenia while maintaining a favorable side effect profile 6.