Starting Dosage of Ziprasidone
For schizophrenia, start ziprasidone at 40 mg twice daily (80 mg/day total) on Day 1, then increase to 80 mg twice daily (160 mg/day total) on Day 2, with all doses taken with food containing at least 500 kcal. 1, 2
Oral Dosing for Schizophrenia
- Initial dose: 40 mg twice daily (80 mg/day) on the first day of treatment 1
- Target dose: Increase to 80 mg twice daily (160 mg/day) by Day 2, as only doses of 120-160 mg/day have demonstrated superiority over placebo in clinical trials 1, 3
- Maximum FDA-approved dose: 160 mg/day (80 mg twice daily) 1
Critical Administration Requirement
- All doses must be taken with food containing ≥500 kcal to achieve adequate bioavailability (~60% with food vs. significantly lower without) 1, 2
- This food requirement is non-negotiable for therapeutic efficacy 2
Oral Dosing for Bipolar I Disorder (Acute Manic/Mixed Episodes)
- Day 1: 40 mg twice daily (80 mg/day) 4, 1
- Day 2 onward: Titrate rapidly to 80 mg twice daily (160 mg/day) 4, 2
- Typical therapeutic range: 40-80 mg twice daily (80-160 mg/day total), with mean effective doses in clinical trials of 112-132 mg/day 1
- Rapid titration to 120-160 mg/day is necessary for optimal efficacy in acute mania 2
Intramuscular Dosing for Acute Agitation
- Initial IM dose: 10-20 mg, with 20 mg demonstrating more significant reduction in agitation scores 5
- Repeat dosing: Can be repeated every 2-4 hours as needed 5
- Maximum daily IM dose: 40 mg/day 4, 5
- Onset of action: 15-30 minutes after injection 5
Common Pitfalls to Avoid
- Do not start at doses below 40 mg twice daily for schizophrenia, as trials using 20 mg twice daily failed to show superiority over placebo 1
- Do not administer without adequate food, as this dramatically reduces bioavailability and therapeutic effect 2
- Do not use in patients with recent MI, baseline QT prolongation, or those taking other QT-prolonging medications due to risk of QTc prolongation 4, 5
- Obtain baseline ECG before initiating treatment to screen for QTc prolongation 4
Adjunctive Medications During Titration
- Temporary short-term benzodiazepines (lorazepam for agitation or temazepam for insomnia) may be used during the initial titration period, as was done in clinical trials 2