Ziprasidone 60mg

Ziprasidone, Zeldox (CDN)/Geodon (US)
Description: Second Generation (Atypical) Antipsychotic

“ALERT: US Boxed Warning

​Increased mortality in elderly patients with dementia-related psychosis:
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at increased risk of death. Ziprasidone is not approved for the treatment of patients with dementia-related psychosis.”

CSA NA – FDA Approved – REMS (N) – Can Ship

Ziprasidone, Zeldox/Geodon is a benzylisothiazolylpiperazine antipsychotic with the exact mechanism being unknown.  Ziprasidone has high affinity for D2, D3, 5-HT2A, 5-HT1A, 5-HT2C, 5-HT1D, and alpha1-adrenergic receptors.  It has moderate affinity for histamine H1 receptors.  It has minimal to no affinity for alpha2-adrenergic receptors, beta-adrenergic, 5-HT3, 5-HT4, cholinergic, mu, sigma, or benzodiazepine receptors.  Ziprasidone functions as an antagonist at the D2, 5-HT2A, and 5-HT1D receptors and as an agonist at the 5-HT1A receptor. Ziprasidone moderately inhibits the reuptake of serotonin and norepinephrine.

Schizophrenia; Bipolar Disorder; Agitation/Aggression 

Before starting Ziprasidone, Zeldox/Geodon make sure your physician is aware of any allergies or medications you currently take, if you have cardiovascular disease, dementia, an electrolyte imbalance, hepatic impairment, renal impairment, have a seizure disorder, are pregnant, or breastfeeding. Ziprasidone, Zeldox/Geodon use has been associated with rare but serious adverse events such as blood dyscrasias, cerebrovascular effects, CNS depression, dermatologic reactions, dyslipidemia, esophageal dysmotility, aspiration, extrapyramidal symptoms, increased risk of falls, hyperglycemia, hyperprolactinemia, neuroleptic malignant syndrome, orthostatic hypotension, priapism, QT prolongation, suicidal ideation, impaired temperature regulation, and weight gain.

Intramuscular Injection: 10 mg every 2 hours or 20 mg every 4 hours (maximum: 40 mg/day)
Oral:  20 to 80 mg twice daily with meal

How to Take: Administer oral dosage form with a meal containing at least 500 calories.  For the injection it is for intramuscular administration only.

You Need to Avoid:  Do not stop this medication suddenly, make sure your physician is aware and can create a tapering schedule so you can come off slowly and prevent any withdrawal symptoms.  This medication has many drug interactions so ask your pharmacist before starting any over the counter medications or supplements.

Drowsiness, extrapyramidal reaction, headache, dizziness, nausea, akathisia, anxiety, weight gain, constipation, dyspepsia, xerostomia, weakness, visual disturbance, respiratory tract infection

Note this is not a complete list of side effects, only the most common

1. Why would my doctor give me an antipsychotic? Does this mean I am psychotic?
   This medication can be used for many conditions outside of its original classification.  It commonly is also used for nonpsychotic mood disorders, but this class of medication was given its name back when we knew a lot less about their capabilities.
2. This medication has a lot of scary side effects, is it safe?
   All medications have side effects however this medication works on a lot of different neurotransmitter receptors in the brain which can lead to a variety of intentional and unintentional effects.  These are mostly dosage dependant and in lower doses the risk is minimal.  In all cases regular lab work will allow your physician to see if your blood sugar, cholesterol etc. start to move in the wrong direction so action can be taken before they become a problem.
3. What are extra-pyramidal reactions?
   Blocking dopamine in the extra-pyramidal system in the central nervous system that regulates posture and skeletal muscle tone may cause a variety of movement disorders.  This can include dystonic reactions (muscular spasms, usually repetitive), akathisia (motor restlessness/uneasiness), pseudoparkinsonism (drug induced Parkinsonism – tremor, rigidity, bradykinesia, etc.), tardive dyskinesia (involuntary complex muscle movements in lower face and extremities).  These side effects are generally dose dependant and generally occur with long term use of medications that block dopamine.  If any of these effects may be occurring, speak to your physician as soon as possible to discuss your options.
4. What is Neuroleptic Malignant Syndrome?
   NMS is a rare but serious reaction from significant blockade of dopamine which can occur from antipsychotic medications or from being on high dosages of levodopa (dopamine analogue) and stopping suddenly.  Presents initially as muscle cramps, tremors, fever, unstable blood pressure, and sudden changes in mental status.  As it progresses over 8-40 hours it can lead to complications of rhabdomyolysis, hyperkalemia, kidney failure, or seizures.  Seek medical attention immediately if this reaction is suspected.