Ziprasidone

Registered South African indications:

• Schizophrenia

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Known QT-interval prolongation including congenital or acquired long QT syndrome
• Recent myocardial infarction
• Uncompensated heart failure
• Cardiac dysrhythmias requiring treatment with Class IA and III anti-dysrhythmic agents
• Coadministration with dofetilide, sotalol, quinidine, mesoridazine, thioridazine, chlorpromazine, droperidol, pimozide, sparfloxacin, gatifloxacin, moxifloxacin, halofantrine, mefloquine, pentamidine, arsenic trioxide, levomethadyl acetate, dolasetron mesylate, probucol or tacrolimus
• Coadministration with agents that have demonstrated QT prolongation as one of their pharmacodynamic effects
• Pregnancy
• Breastfeeding
• Safety and efficacy have not been evaluated in children under the age of 18 years

Cautions

• Renal impairment (inj)
• Hepatic impairment
• Elderly
• Cardiovascular disease
• Dementia
• Electrolyte imbalances
• Parkinson disease
• Risk of seizures
• Abrupt withdrawal

Forms avail. in SA and covered in this monograph: cap, inj

Schizophrenia

• Oral (cap): Initial: 40mg, 12hrly; Titrate at intervals of 2 days; Max: 80mg/12hrs

Bipolar mood disorder

• Oral (cap): Initial: 40mg, 12hrly; Increase by 20mg, 12hrly at intervals of 2 days; Maintenance: 40-80mg, 12hrly; Max: 80mg/12hrs

Acute agitation (schizophrenia)

• IM: 10mg, 2hrly as required; Max; 40mg/24hrs
  OR
• IM: 20mg, 4hrly; Max; 40mg/24hrs

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Oral therapy should replace IM administration as soon as possible

Not established for use in children below 18 years (see Contraindications)

Pregnancy

• Contraindicated

Breastfeeding

• Contraindicated

Renal Impairment

• Oral: No dose adjustment recommended
• IM: Caution; no dose adjustment recommended

Hepatic Impairment

• Caution; no dose adjustment recommended

Elderly

• Caution; no dose adjustment recommended 
  Initiate at lower end of dosage range; Titrate gradually as needed

Porphyria Information

• Probably not porphyrinogenic (PNP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Drowsiness
• Extrapyramidal symptoms 
• Headache
• Dizziness
• Akathisia
• Anxiety
• Hypoesthesia
• Agitation
• Personality disorder
• Speech disturbance
• Amnesia
• Ataxia
• Confusion
• Delirium
• Dystonia
• Hypothermia
• Vertigo
• Withdrawal syndrome
• Paralysis
• Insomnia
• Paraesthesia
• Abnormal gait
• Dyskinesia
• Choreoathetosis
• Twitching

Cardiovascular Disorders

• Orthostatic hypotension
• Chest pain
• Hypertension
• Tachycardia
• Bradycardia
• Facial oedema
• Angina pectoris
• Peripheral oedema
• Atrial fibrillation

Respiratory Disorders

• Respiratory tract infection
• Rhinitis
• Cough 
• Pharyngitis
• Dyspnoea
• Pneumonia

Gastrointestinal Disorders

• Nausea and vomiting
• Flank pain
• Constipation
• Dyspepsia
• Xerostomia
• Diarrhoea
• Sialorrhoea
• Abdominal pain
• Anorexia
• Dysphagia
• Buccoglossal syndrome
• Rectal haemorrhage

Hepatobiliary Disorders

• Increased serum alkaline phosphatase
• Increased serum transaminases

Genitourinary Disorders

• Haematuria
• Impotence
• Priapism
• Urinary retention
• Polyuria
• Anorgasmia
• Male sexual disorder

Endocrine and Metabolic Disorders

• Weight gain
• Albuminuria
• Amenorrhoea
• Dehydration
• Glycosuria
• Hypercholesterolemia
• Hyperglycemia
• Hypermenorrhoea
• Hypokalemia
• Increased lactate dehydrogenase
• Increased thirst
• Dysmenorrhoea
• Lactation

Musculoskeletal Disorders

• Weakness
• Myalgia
• Hypotonia
• Tremor
• Hypertonia
• Increased creatine phosphokinase
• Tenosynovitis

Skin and Subcutaneous Tissue Disorders

• Skin rash
• Fungal dermatitis
• Diaphoresis
• Furunculosis
• Skin photosensitivity
• Alopecia
• Contact dermatitis
• Maculopapular rash
• Urticaria
• Vesiculobullous dermatitis
• Pain at injection site

Immune, Blood and Lymphatic System Disorders

• Anaemia
• Eosinophilia
• Leukocytosis
• Leukopenia
• Lymphadenopathy
• Tongue oedema
• Epistaxis

Sensory Disorders

• Visual disturbance
• Diplopia
• Oculogyric crisis
• Blepharitis
• Cataract
• Conjunctivitis
• Photophobia
• Xerophthalmia
• Tinnitus

• Amisulpride
• Analgesics
• Dopamine agonists
• Central nervous system depressants
• Fluoxetine
• QT prolonging agents
• Dofetilide
• Sotalol
• Quinidine
• Mesoridazine
• Thioridazine
• Chlorpromazine
• Droperidol
• Pimozide
• Sparfloxacin
• Gatifloxacin
• Moxifloxacin
• Halofantrine
• Mefloquine
• Pentamidine
• Arsenic trioxide
• Levomethadyl acetate
• Dolasetron mesylate
• Probucol
• Tacrolimus
• Agents lowering seizure threshold
• Metoclopramide
• Piribedil
• Saquinavir
• Sulpiride

• Blood pressure
• Weight
• Electrolytes
• Hepatic function
• Blood glucose
• Serum lipids
• Ophthalmic examination

Specific cases may require

• ECG 
• Full blood count

The exact mechanism of action of ziprasidone is unknown, but it is likely that its antipsychotic effects are due to its antagonistic action at mesolimbic dopamine-2 receptors (postive symptoms) and serotonin-2A receptors (negative symptoms) in the frontal lobe.

Capsule 20mg

• Geodon (UpJohn) originator

Capsule 40mg

• Geodon (UpJohn) originator

Capsule 60mg 

• Geodon (UpJohn) originator

Capsule 80mg

• Geodon (UpJohn) originator

Injection (per ml) 20mg

• Geodon (UpJohn) originator