ziprasidone

General information

• Class: Antipsychotic
• Common US brands: GEODON
• Typical dose range: 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).
• Therapeutic drug monitoring not routinely recommended.
• Last reviewed: 2025-09-23

Dosing & forms

• Forms/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.
• Frequency: 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).
• Food: Take with food.
• Typical range: 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).

Mechanism (brief)

D2 and 5‑HT2A antagonism; 5‑HT1A agonism; inhibits 5‑HT/NE reuptake.

Metabolism & Half‑life

• Metabolism: Aldehyde oxidase, CYP3A4 (minor)
• Half‑life: Steady-state mean 7 h

Therapeutic Drug Monitoring (TDM)

Recommended: No

Monitoring highlights

• 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).

Sources

• GEODON label — DailyMed
• The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia — American Psychiatric Association (2020)
• AGNP Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology — Pharmacopsychiatry (2018)
• Ziprasidone in the treatment of acute manic or mixed episodes of bipolar disorder: a randomized, double-blind, placebo-controlled trial — American Journal of Psychiatry (2003)
• Ziprasidone in the treatment of acute schizophrenia: a randomized, double-blind, placebo-controlled trial — Psychopharmacology (2001)