What are the sexual side effects of ziprasidone (Geodon)?

Sexual Side Effects of Ziprasidone (Geodon)

Ziprasidone has a lower incidence of sexual side effects compared to many other antipsychotics, making it a favorable option for patients concerned about sexual dysfunction. 1, 2

Overview of Ziprasidone's Sexual Side Effect Profile

• Ziprasidone is one of the more weight-neutral antipsychotics with fewer metabolic effects, which indirectly benefits sexual function compared to medications that cause significant weight gain and metabolic disturbances 1, 2
• Unlike many other antipsychotics and SSRIs, ziprasidone does not cause significant persistent effects on prolactin levels, which helps minimize sexual dysfunction 3
• Ziprasidone has a unique pharmacological profile as a 5-HT1A receptor agonist and antagonist at 5-HT2A, 5-HT2C, and 5-HT1B/1D receptors, which may contribute to its favorable sexual side effect profile 4

Specific Sexual Side Effects

• Sexual dysfunction with ziprasidone is less common than with many other antipsychotics, particularly those that significantly raise prolactin levels 3
• In rare cases, ziprasidone has been associated with spontaneous orgasm without sexual arousal, reported in a case study of a bipolar patient - a paradoxical effect not commonly seen with antipsychotics 5
• When sexual side effects do occur with ziprasidone, they may include:
  • Decreased libido (less common than with other antipsychotics) 1
  • Erectile dysfunction (less frequent than with SSRIs or other antipsychotics) 1
  • Delayed ejaculation or anorgasmia (less common than with SSRIs) 1

Comparison to Other Antipsychotics

• Ziprasidone tends to have fewer metabolic effects compared to olanzapine, quetiapine, risperidone, and clozapine, which indirectly benefits sexual function 1, 2
• Aripiprazole and ziprasidone tend to have fewer metabolic effects than other second-generation antipsychotics, making them preferable options when sexual function is a concern 1
• Haloperidol, clozapine, quetiapine, and risperidone tend to have more metabolic effects that can indirectly impact sexual function 1

Clinical Considerations

• When prescribing ziprasidone, monitor for the rare occurrence of sexual side effects, but be aware they are less common than with many other antipsychotics 3, 6
• Ziprasidone must be administered with a 500 kcal meal to ensure proper absorption; inadequate absorption due to improper administration cannot be compensated for by increasing the dose 3
• The target dose range of 120-160 mg/day is associated with optimal symptom control and greater persistence with treatment 3
• Monitor for QTc interval prolongation, especially in patients with pre-existing cardiac conditions or those taking other QT-prolonging medications 2, 6

Management of Sexual Side Effects

• If sexual side effects occur with ziprasidone, consider:
  • Evaluating if the medication is being taken with adequate food (500 kcal meal) 3
  • Assessing for other contributing factors (other medications, medical conditions, psychological factors) 1
  • Adjusting the dose if appropriate while maintaining therapeutic efficacy 3
  • Considering a switch to another antipsychotic with even lower risk of sexual side effects if sexual dysfunction is significantly impacting quality of life 2

Remember that sexual dysfunction is common in patients with psychiatric disorders even before treatment, with studies showing high prevalence rates (50% in men, 68% in women) prior to medication initiation 7.