Geodon (Ziprasidone) Does Not Require Renal Dose Adjustment
No renal dose adjustment is necessary for ziprasidone in patients with any degree of renal impairment, including those requiring hemodialysis. 1
Pharmacokinetic Rationale
Ziprasidone is highly metabolized by the liver with less than 1% excreted unchanged in urine, making renal impairment unlikely to significantly impact drug clearance 1
A multiple-dose pharmacokinetic study (20 mg twice daily for 8 days) in 27 subjects with varying degrees of renal impairment demonstrated similar drug exposure (AUC and Cmax) compared to subjects with normal renal function 1
Ziprasidone is not removed by hemodialysis, so no supplemental dosing is needed post-dialysis 1
Clinical Study Evidence
Research data from 39 subjects with renal impairment (ranging from mild to severe requiring hemodialysis) showed no clinically significant differences in ziprasidone pharmacokinetics across all groups 2:
- Mean AUC values on day 8 were 446,650,389, and 427 ng/mL·h for normal, mild, moderate, and severe renal impairment groups respectively 2
- While the mild impairment group showed statistically higher AUC, this was not considered clinically significant 2
- Hemodialysis had no clinically significant effect on ziprasidone pharmacokinetics 2
Important Clinical Considerations
The critical factor for ziprasidone effectiveness is food administration, not renal function:
- Ziprasidone must be administered with a 500 kcal meal to ensure adequate absorption 3
- Without food, absorption is substantially reduced and cannot be compensated by increasing the dose 3
Standard dosing applies regardless of renal function:
- Target therapeutic dose range: 120-160 mg/day for optimal symptom control 3
- No dose reduction needed even in end-stage renal disease 1
Common Pitfalls to Avoid
- Do not reduce ziprasidone dose based on renal function alone—this will result in subtherapeutic levels 1, 2
- Do not confuse ziprasidone with other psychiatric medications that do require renal adjustment 1
- Ensure adequate caloric intake with each dose (500 kcal meal) to maintain therapeutic drug levels 3