Educational only — not medical advice. If you’re in crisis or thinking about suicide: call or text 988 (U.S.) or your local emergency number. Support resources. Under construction and review—see the updates log.

ziprasidone

Antipsychotic

Brand: GEODON

Published 2025-09-16 · Last reviewed 2025-09-23 · 5 references

Content sourced from FDA labeling (DailyMed) and peer-reviewed literature.

Print sheet Review evidence

At a glance

Class: Antipsychotic·Typical dose: Schizophrenia: start 20 mg twice daily with food; increase to 40 mg BID on day 3; maintenance 40–80 mg BID (max 100 mg BID).·Half-life: Steady-state mean 7 h·LAI available: No

Class: Antipsychotic
Typical dose: Schizophrenia: start 20 mg twice daily with food; increase to 40 mg BID on day 3; maintenance 40–80 mg BID (max 100 mg BID).
Half-life: Steady-state mean 7 h
LAI available: No

Quick answers

What is ziprasidone?: Ziprasidone (brand Geodon) is a second-generation antipsychotic with minimal metabolic impact but a notable propensity for QT prolongation, indicated for schizophrenia and bipolar mania.
What is GEODON?: GEODON is a brand name for ziprasidone.
What is GEODON (ziprasidone) used for?: Label indications include: Schizophrenia (adults); Bipolar I mania/mixed (adults).
What drug class is GEODON (ziprasidone)?: Atypical Antipsychotic.
What is the mechanism of action of GEODON (ziprasidone)?: D2 and 5‑HT2A antagonism; 5‑HT1A agonism; inhibits 5‑HT/NE reuptake.
What strengths does GEODON (ziprasidone) come in?: Oral capsules: 20 mg, 40 mg, 60 mg, 80 mg (must be taken with ≥500 calories).
Is GEODON (ziprasidone) a controlled substance?: No — it is not scheduled as a controlled substance under U.S. federal law.
What is GEODON (ziprasidone) dosing for schizophrenia?: Schizophrenia: start 20 mg twice daily with food; increase to 40 mg BID on day 3; maintenance 40–80 mg BID (max 100 mg BID).

General information

Ziprasidone (brand Geodon) is a second-generation antipsychotic with minimal metabolic impact but a notable propensity for QT prolongation, indicated for schizophrenia and bipolar mania.

This profile focuses on adult schizophrenia and acute manic/mixed episodes where twice-daily dosing with food is acceptable.

The compare view and the ziprasidone evidence feed can help weigh weight neutrality, dosing logistics, and QTc risk against similarly positioned SGAs when evaluating cardiovascular monitoring or augmentation needs.

Coordinate care plans through the schizophrenia hub and bipolar disorder hub to align relapse prevention, metabolic labs, and alternative depot strategies.

U.S. approvals

Schizophrenia (adults) (2001)
Bipolar I mania/mixed (adults) (2004)

Formulations & strengths

Oral capsules: 20 mg, 40 mg, 60 mg, 80 mg (must be taken with ≥500 calories).
Short-acting IM injection: 10 mg/mL (reconstituted 20 mg vial) for acute agitation.

Generic availability

Generic capsules available since 2012; injectable generics introduced in 2019.

Selected for patients needing weight-neutral therapy, with careful cardiac screening; adherence depends on food requirement and BID dosing.

View labelExact

Mechanism of action

Refer to the Glossary entry on Neurotransmitters for background on receptor systems involved in serious mental illness.

Ziprasidone antagonizes dopamine D2 and serotonin 5-HT2 receptors while partially agonizing 5-HT1A and inhibiting serotonin/norepinephrine reuptake, supporting mood stabilization.

Moderate histamine H1 and α1 antagonism contributes to sedation and orthostasis; minimal muscarinic activity limits anticholinergic effects.

Antagonist at dopamine D2/D3 receptors.
Antagonist at serotonin 5-HT2A/5-HT2C/5-HT1D; partial agonist at 5-HT1A; inhibitor of serotonin and norepinephrine transporters.
Moderate antagonist at histamine H1 and adrenergic α1 receptors.

Metabolism & pharmacokinetics

Oral bioavailability ~60% when taken with ≥500 calories; falls markedly if fasting.
Greater than 99% protein bound with modest volume of distribution (~1.5 L/kg).
Metabolized primarily by aldehyde oxidase and CYP3A4 (minor) to inactive metabolites.
Half-life ~7 hours orally; IM half-life 2–3 hours.
Eliminated ~59% in feces and ~20% in urine, mostly as metabolites.

Dosing & administration

Schizophrenia: start 20 mg twice daily with food; increase to 40 mg BID on day 3; maintenance 40–80 mg BID (max 100 mg BID).
Bipolar mania: start 40 mg BID with food; titrate to 60–80 mg BID within several days as tolerated.
IM agitation: 10–20 mg IM every 2–4 hours as needed (max 40 mg/day); transition to oral therapy when feasible.

Monitoring & labs

Baseline ECG for patients with cardiac disease, electrolyte abnormalities, or QT-active co-medications; repeat after dose increases and for symptoms (palpitations, syncope).
Electrolytes (potassium, magnesium) when risk factors for depletion are present (diuretics, vomiting/diarrhea, eating disorders) to reduce QTc risk.
Food adherence: confirm each dose is taken with ≥500 calories (meal planning, reminders) because fasting dosing can mimic nonresponse.
Orthostatic vitals and sedation during titration, especially in older adults and when antihypertensives or other CNS depressants are used.
EPS/AIMS monitoring at routine intervals (akathisia and parkinsonism can occur, particularly at higher doses).

Ziprasidone monitoring centers on QTc safety and on reliable food intake, since absorption is meal-dependent and missed-meal dosing undermines treatment.

Adverse effects

FDA boxed warnings

Increased mortality in elderly patients with dementia-related psychosis (class warning).

Common side effects (≥10%)

Somnolence: Approximately 14% in trials.
Headache: About 12% overall.
Nausea: Roughly 10%.
Dizziness: Around 10%.

Other notable effects

QT prolongation (mean 10–20 msec) necessitates baseline cardiac assessment and avoidance with other QT-active drugs; consider alternative LAIs via the LAI Navigator when sustained depot coverage is required.
Minimal weight gain and metabolic changes but continue standard monitoring.
Moderate EPS risk at higher doses; monitor for akathisia and parkinsonism.
Rare drug reaction with eosinophilia and systemic symptoms (DRESS).

Interactions

Avoid coadministration with other QT-prolonging agents (e.g., class IA/III antiarrhythmics, moxifloxacin) to reduce torsades risk.
CYP3A4 inhibitors (ketoconazole, clarithromycin) modestly raise levels—monitor QT interval and tolerability.
CYP3A4 inducers (carbamazepine, rifampin) may lower exposure—monitor efficacy and adjust if needed.
Additive CNS depression with alcohol, benzodiazepines, opioids.
Caution with antihypertensives due to orthostatic hypotension.

Other useful information

Instruct patients to take each dose with ≥500 calories to ensure therapeutic exposure.
Obtain baseline ECG in patients with cardiac disease, electrolyte disturbances, or on other QT-active regimens; repeat if dose increases or symptoms arise.
Educate patients on symptoms of arrhythmia (palpitations, syncope) and advise immediate evaluation if they occur.

References

Related hubs:Schizophrenia hub·Bipolar hub