From the FDA Drug Label
2.2 Schizophrenia Dose Selection Ziprasidone capsules should be administered at an initial daily dose of 20 mg twice daily with food.
2.3 Bipolar I Disorder (Acute Mixed or Manic Episodes and Maintenance Treatment as an Adjunct to Lithium or Valproate) Acute Treatment of Manic or Mixed Episodes In adults oral ziprasidone should be administered at an initial daily dose of 40 mg twice daily with food
The starting dose of Geodon (ziprasidone) is:
- 20 mg twice daily for schizophrenia
- 40 mg twice daily for bipolar I disorder (acute mixed or manic episodes) 1
From the Research
The starting dose of Geodon (ziprasidone) for adults with schizophrenia is typically 20 mg twice daily with food, as supported by the most recent and highest quality study available 2.
Key Considerations
- For bipolar mania, treatment usually begins at 40 mg twice daily with food, increasing to 60 or 80 mg twice daily on the second day of treatment if needed.
- Food significantly enhances the absorption of ziprasidone, increasing bioavailability by approximately 100%, so taking it with meals is essential for proper effectiveness.
- Elderly patients or those with hepatic impairment may require lower starting doses.
- For intramuscular injection (used for acute agitation in schizophrenia), the recommended dose is 10-20 mg as needed, with a maximum daily dose of 40 mg.
- Patients should be monitored for QT prolongation, especially when starting the medication, as ziprasidone can affect cardiac conduction.
- Gradual dose titration is recommended to minimize side effects such as sedation, dizziness, and extrapyramidal symptoms while achieving therapeutic benefit.
Comparison with Other Studies
- A study from 2006 3 compared the effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia, finding that risperidone and olanzapine were more effective than quetiapine and ziprasidone.
- Another study from 2005 4 reviewed the efficacy of olanzapine and ziprasidone for the treatment of schizophrenia, concluding that olanzapine had a larger body of evidence supporting its efficacy.
- A review of atypical antipsychotics for bipolar disorder from 2005 5 suggested that olanzapine, risperidone, quetiapine, aripiprazole, and ziprasidone were effective in acute mania, but further studies were needed to determine their utility in acute bipolar depression and maintenance treatment.
Clinical Implications
- The choice of starting dose and titration schedule should be individualized based on the patient's clinical response and tolerability.
- Regular monitoring of QT interval and other potential side effects is essential to ensure safe and effective treatment with ziprasidone.
- Further research is needed to fully establish the efficacy and safety of ziprasidone in various patient populations and clinical settings.