Ziprasidone belongs to the class of medications called antipsychotics. It is used to control the symptoms of schizophrenia and the manic phase of bipolar disorder. It works by adjusting the balance of chemicals in the brain that are involved in schizophrenia.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

How should I use this medication?

For the treatment of schizophrenia, the usual adult starting dose of ziprasidone is 40 mg twice daily, although a lower dose may be used. The dose can be increased gradually every 2 days up to 80 mg twice daily, as recommended by the doctor.

For the treatment of the manic phase of bipolar disorder, the recommended adult starting dose is 40 mg twice daily for 1 day, then increased to 60 mg or 80 mg twice daily.

For maintenance treatment, your doctor will recommend an appropriate dose for you.

The capsules should be swallowed whole with a glass of water. Do not open, crush, or chew the capsules. Take this medication with food at the same time every day.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Continue to take this medication regularly, even if you feel better. This will prevent the symptoms from returning. It is important to take this medication exactly as prescribed by your doctor. If you miss a dose by only a few hours, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

For the treatment of schizophrenia, the usual adult starting dose of ziprasidone is 40 mg twice daily, although a lower dose may be used. The dose can be increased gradually every 2 days up to 80 mg twice daily, as recommended by the doctor.

For the treatment of the manic phase of bipolar disorder, the recommended adult starting dose is 40 mg twice daily for 1 day, then increased to 60 mg or 80 mg twice daily.

For maintenance treatment, your doctor will recommend an appropriate dose for you.

The capsules should be swallowed whole with a glass of water. Do not open, crush, or chew the capsules. Take this medication with food at the same time every day.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Continue to take this medication regularly, even if you feel better. This will prevent the symptoms from returning. It is important to take this medication exactly as prescribed by your doctor. If you miss a dose by only a few hours, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

20 mg
Each blue opaque cap/off-white opaque body, size "5" hard gelatin capsule shell, filled with creamy to pale pinkish granular powder and imprinted with "F" on the blue opaque cap and "26" on the off-white opaque body with black ink, contains 20 mg of ziprasidone. Nonmedicinal ingredients: ethylcellulose, lactose monohydrate, pregelatinised starch, and magnesium stearate; Capsule shell: FD&C Blue 2, titanium dioxide, gelatin, and sodium lauryl sulfate.

40 mg
Each blue opaque cap/blue opaque body, size "3" hard gelatin capsule shell, filled with creamy to pale pinkish granular powder and imprinted with "F" on the blue opaque cap and "38" on the off-white opaque body with black ink, contains 40 mg of ziprasidone. Nonmedicinal ingredients: ethylcellulose, lactose monohydrate, pregelatinised starch, and magnesium stearate; Capsule shell: FD&C Blue 2, titanium dioxide, gelatin, and sodium lauryl sulfate.

60 mg
Each off-white opaque cap/off-white opaque body, size "2" hard gelatin capsule shell, filled with creamy to pale pinkish granular powder and imprinted with "F" on the blue opaque cap and "39" on the off-white opaque body with black ink, contains 60 mg of ziprasidone. Nonmedicinal ingredients: ethylcellulose, lactose monohydrate, pregelatinised starch, and magnesium stearate; Capsule shell: FD&C Blue 2, titanium dioxide, gelatin, and sodium lauryl sulfate.

80 mg
Each blue opaque cap/off-white opaque body, size "1" hard gelatin capsule shell, filled with creamy to pale pinkish granular powder and imprinted with "X" on the blue opaque cap and "66" on the off-white opaque body with black ink, contains 80 mg of ziprasidone. Nonmedicinal ingredients: ethylcellulose, lactose monohydrate, pregelatinised starch, and magnesium stearate; Capsule shell: FD&C Blue 2, titanium dioxide, gelatin, and sodium lauryl sulfate.

Do not take this medication if you:

• are allergic to ziprasidone or any ingredients of the medication
• are taking medications such as dofetilide, sotalol, quinidine, mesoridazine, thioridazine, chlorpromazine, droperidol, pimozide, moxifloxacin, halofantrine, mefloquine, pentamidine, arsenic trioxide, levomethadyl acetate, probucol, tacrolimus, or any other medication that can cause QT prolongation (a specific type of heart arrhythmia)
• have, or have a history of, QT prolongation (including congenital long QT syndrome)
• have recently had a heart attack
• have severe heart failure

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• constipation
• cough
• diarrhea
• dizziness
• fatigue
• flu-like symptoms (e.g., fever, sore throat, chills)
• leakage of fluid or milk from breasts (women)
• menstrual changes
• nausea or upset stomach
• rash
• restlessness
• runny nose
• sexual difficulties
• weight gain

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• abnormal movements of the face or tongue
• abnormal walking
• changes in body temperature, or feeling very hot and unable to cool down
• dizziness, especially when standing from a lying down or seated position
• fainting, losing consciousness, or feeling a change in the way your heart beats
• falls
• feeling very hot and unable to cool down (usually after exercise, dehydration, or being in a warm place)
• high blood pressure
• muscle twitching
• new or worsening constipation
• signs of a blood clot in the arm or leg (tenderness, pain, swelling, warmth, or redness in the arm or leg) or lungs (difficulty breathing, sharp chest pain that is worse when breathing in, coughing, coughing up blood, sweating, or passing out)
• signs of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
• signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• abnormal heart rhythms (e.g., fast or slow heart rate, palpitations), fainting, or seizures
• painful erection lasting longer than 4 hours
• seizures
• signs of neuroleptic malignant syndrome (e.g., confusion, reduced consciousness, high fever, or muscle stiffness)
• skin rash and fever with swollen glands
• symptoms of a severe allergic reaction (e.g., itching or skin rash; shortness of breath; swelling of the face, lips, or tongue)
• signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
• symptoms of serotonin toxicity (e.g., confusion, fast heartbeat, hallucinations, restlessness, shaking, shivering, sudden jerking of muscles, sweating)
• symptoms of a stroke (e.g., sudden weakness or numbness of the face, arms, or legs [especially on one side]; slurred speech; vision problems)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Abnormal heart rhythms: This medication can cause abnormal heart rhythms. Certain medications (e.g., sotalol, quinidine, thioridazine, chlorpromazine, pimozide, moxifloxacin, mefloquine, pentamidine, arsenic trioxide, tacrolimus) can increase the risk of a type of abnormal heart rhythm called QT prolongation, and should not be used in combination with ziprasidone. You are more at risk for this type of abnormal heart rhythm and its complications if you:

• are female
• are older than 65 years of age
• have a family history of sudden cardiac death
• have a history of heart disease or abnormal heart rhythms
• have a slow heart rate
• have congenital prolongation of the QT interval
• have diabetes
• have had a stroke
• have low potassium, magnesium, or calcium levels
• have nutritional deficiencies

If you have any of these risk factors, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Blood clots: Ziprasidone may increase the risk of blood clots, especially in the lower leg. Talk to your doctor or pharmacist if you have risk factors for developing blood clots (e.g., a family history of blood clots, recent major surgery, immobility due to air travel, or other reason).

Blood sugar: This medication may cause high blood sugar levels and a loss of blood glucose control. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication. If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. If you experience weakness, increased thirst, increased urination, and increased appetite while taking this medication, contact your doctor.

Body temperature: This medication, like other antipsychotic medications, can disrupt the body's ability to control body temperature. People who exercise vigorously, who are exposed to extreme heat, are dehydrated, or are taking anticholinergic medications (e.g., benztropine, oxybutynin) are more at risk. Contact your doctor as soon as possible if you feel very hot and are unable to cool down while taking this medication.

Drowsiness/reduced alertness: Ziprasidone may interfere with activities requiring mental alertness. Avoid driving or potentially hazardous activities until you know how this medication affects you.

Lactose: This medication contains lactose. If you have hereditary problems of galactose intolerance, lactase deficiency, or glucose-galactose malabsorption discuss the appropriateness of this medication with your doctor.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

Low blood pressure: Ziprasidone may cause low blood pressure when rising from a sitting or lying down position. If you feel dizzy, lightheaded, feel your pulse racing, or if you faint, call your doctor. While you are taking this medication, get up slowly after you have been sitting or lying down.

Neuroleptic malignant syndrome (NMS): Ziprasidone, like other antipsychotic medications, can cause a potentially fatal syndrome known as neuroleptic malignant syndrome (NMS). If you notice the symptoms of NMS such as high fever, muscle stiffness, confusion or loss of consciousness, sweating, racing or irregular heartbeat, or fainting, get immediate medical attention.

Prolactin levels: As with other antipsychotics, ziprasidone can elevate levels of the hormone prolactin. This may lead to symptoms such as spontaneous flow of milk from the breast, irregular menstruation, breast enlargement (men), diminished sexual function (men), and decreased bone strength. If you experience any of these symptoms, contact your doctor.

Seizures: Ziprasidone may increase the risk of seizures, especially for people who have had seizures in the past. If you have a seizure disorders or a history of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Serotonin syndrome: Severe reactions are possible when ziprasidone is combined with other medications that act on serotonin, such as tricyclic antidepressants and serotonin reuptake inhibitors, which are used to treat depression. These combinations must be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, and changes in mental state including delirium and agitation. Coma and death are possible.

If you are taking antidepressants, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Suicidal behaviour: People with mental illness may experience feelings of wanting to hurt themselves or others. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking this medication.

Tardive dyskinesia (TD): Ziprasidone, like some other antipsychotic medications may cause tardive dyskinesia (TD) to develop. TD is a potentially irreversible syndrome of involuntary, repetitive movements of the face and tongue muscles. Although TD most commonly happens to seniors, especially women, it is impossible to predict who will develop TD. The risk of developing TD increases with higher doses and long-term treatment. If you experience muscle twitching or abnormal movements of the face or tongue, contact your doctor as soon as possible.

White blood cells: As with other antipsychotics, ziprasidone can lower the number of infection-fighting white blood cells in your blood. This can increase your risk of infections. If you experience frequent colds or other infections, contact your doctor. Your doctor will monitor your white blood cell levels with blood tests during treatment with ziprasidone.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Babies born to mothers who take this medication in the last 3 months of pregnancy may experience withdrawal symptoms after they are born, including breathing problems, difficulty feeding, or irritability. If you have been taking this medication during pregnancy, make sure you tell everyone involved in caring for you and your baby.

Breast-feeding: This medication may pass into breast milk. If you are breast-feeding and are taking ziprasidone, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children less than 18 years of age.

Seniors: The safety of using this medication has not been established for adults 65 years of age or older. The increased risk of liver, kidney, and heart conditions increases the risk of side effects with the use of ziprasidone.

There may be a higher risk of strokes, heart attacks, and deaths associated with the use of ziprasidone by seniors with dementia. Seek medical attention immediately if you notice the signs and symptoms of a stroke (e.g., sudden weakness or numbness, speech problems, vision problems, dizziness, confusion, sudden severe headache), a heart attack (e.g., discomfort or pain in the chest, back, neck, jaw, arms; sweating; shortness of breath; nausea; lightheadedness), or infection (e.g., pneumonia). Ziprasidone should not be used by seniors with dementia.

There may be an interaction between ziprasidone and any of the following:

• alcohol
• alfuzosin
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• angiotensin converting enzyme inhibitors (ACEIs; captopril, ramipril)
• angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
• antihistamines (e.g., azelastine, cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
• antiseizure medications (e.g., carbamazepine, clobazam, levetiracetam, phenytoin, primidone, topiramate, valproic acid, zonisamide)
• anti-Parkinsons medications (e.g., amantadine, apomorphine, bromocriptine, levodopa, pramipexole, ropinirole, rotigotine)
• antipsychotic medications (e.g., haloperidol, risperidone, quetiapine)
• arsenic trioxide
• "azole" antifungals (e.g., fluconazole, ketoconazole, voriconazole)
• barbiturates (e.g., butalbital, phenobarbital)
• benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
• beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
• brimonidine
• buprenorphine
• bupropion
• buserelin
• cabergoline
• calcium channel blockers (e.g., amlodipine, diltiazem, verapamil)
• cannabis
• capecitabine
• chloral hydrate
• clonidine
• conivaptan
• degarelix
• dexmethylphenidate
• diabetes medications (e.g., acarbose, dapagliflozin, glyburide, insulin, linagliptin, lixisenatide, metformin, rosiglitazone)
• diphenoxylate
• disopyramide
• diuretics (e.g., furosemide, hydrochlorothiazide)
• domperidone
• doxepin
• dronedarone
• esketamine
• fingolimod
• flecainide
• flunarizine
• galantamine
• HIV protease inhibitors (e.g., indinavir, atazanavir, lopinavir, nelfinavir,)
• hydroxychloroquine
• indacaterol
• lemborexant
• leuprolide
• lithium
• loperamide
• macrolide antibiotics (e.g., azithromycin, clarithromycin, erythromycin)
• mefloquine
• methadone
• methylphenidate
• metoclopramide
• mifepristone
• mirtazapine
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, rasagiline, phenelzine, selegiline, tranylcypromine)
• muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine, tizanidine)
• narcotic pain relievers (e.g., codeine, fentanyl, morphine, oxycodone, tapentadol, tramadol)
• ondansetron
• pentamidine
• pitolisant
• pomalidomide
• pregabalin
• primaquine
• procainamide
• propafenone
• quinidine
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, moxifloxacin, norfloxacin)
• rilpivirine
• romidepsin
• sacubitril
• salmeterol
• scopolamine
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• serotonin antagonists (antinausea medications; e.g., granisetron, ondansetron)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
• solifenacin
• sotalol
• tacrolimus
• tamoxifen
• tetrabenazine
• trazodone
• tricyclic antidepressants (e.g., amitriptyline, desipramine)
• tyrosine kinase inhibitors (e.g., dasatinib, imatinib, nilotinib, sunitinib)
• triptorelin
• tryptophan
• valerian
• vardenafil
• zolpidem
• zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.