From the Research
Ziprasidone can cause orthostatic hypotension, particularly at higher doses, and the risk is highest during the first few days of treatment and when dosage is rapidly increased, as supported by studies such as 1 which found that higher doses of ziprasidone were associated with reductions in diastolic blood pressure. To minimize this risk, ziprasidone should be started at a low dose and gradually titrated upward.
- The recommended starting dose is 20 mg twice daily with meals, with gradual titration upward by 20 mg increments every 2-3 days as tolerated.
- Doses of 80-160 mg/day are more likely to cause orthostatic hypotension than lower doses of 20-40 mg/day.
- Elderly patients, those with cardiovascular disease, dehydration, or those taking other medications that lower blood pressure are at increased risk. Orthostatic hypotension occurs because ziprasidone blocks alpha-1 adrenergic receptors, causing vasodilation and decreased peripheral vascular resistance, as discussed in studies such as 2 and 3. Patients should be advised to:
- Rise slowly from sitting or lying positions
- Stay well-hydrated
- Report symptoms like dizziness, lightheadedness, or fainting Blood pressure monitoring is recommended during the initial titration period, especially when doses exceed 80 mg/day, as suggested by studies such as 4 which provides recommendations on the treatment of orthostatic hypotension. It is also important to note that the treatment of orthostatic hypotension should focus on relieving symptoms and preventing falls, as discussed in 5 and 4.