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)?
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).
Snapshot
- Class: Antipsychotic
- Common US brands: GEODON
- Therapeutic drug monitoring not routinely recommended.
- Last reviewed: 2025-09-23
Clinical Highlights
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. The side-by-side view and the ziprasidone evidence feed can help compare ziprasidone with other weight-neutral SGAs when reviewing ECG changes or augmentation options.
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- This profile focuses on adult schizophrenia and acute manic/mixed episodes where twice-daily dosing with food is acceptable.
- Selected for patients needing weight-neutral therapy, with careful cardiac screening; adherence depends on food requirement and BID dosing.
- The food requirement is the most common failure mode: if doses are taken without a real meal, exposure drops and relapse risk rises; for patients with irregular eating patterns or nausea, this can make ziprasidone a poor fit.
- Schizophrenia (adults) (FDA 2001)
- Bipolar I mania/mixed (adults) (FDA 2004)
- Generic: Generic capsules available since 2012; injectable generics introduced in 2019.
Dosing & Formulations
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.
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- 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 & Risks
Boxed warning: Increased mortality in elderly patients with dementia-related psychosis (class warning). Somnolence: Approximately 14% in trials.
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- Headache: About 12% overall.
- Nausea: Roughly 10%.
- Dizziness: Around 10%.
- QT prolongation (mean 10–20 msec) necessitates baseline cardiac assessment and avoidance with other QT-active drugs; explore depot alternatives in the LAI Navigator if sustained coverage is required.
Drug 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.
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- 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.
Practice Notes
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.
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- Educate patients on symptoms of arrhythmia (palpitations, syncope) and advise immediate evaluation if they occur. Coordinate relapse prevention via the schizophrenia hub and bipolar disorder hub when switching from or to depot therapies.
References
- GEODON (ziprasidone) prescribing information — Pfizer (2024)
- 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)
- Metabolic AND Endocrine Adverse Effects OF Second Generation Antipsychotics: A Systematic Review — CNS Drugs (2011)
- The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia — American Psychiatric Association (2020)Guidelineschizophreniaclinical