TaperCommunityziprasidone
Boxed Warning
Increased mortality in elderly patients with dementia-related psychosis.
Ziprasidone is an atypical antipsychotic for schizophrenia and acute mania. Lower metabolic burden than most atypicals but among the highest QT-prolongation risks in the class. Must be taken with food (≥500 calories) for proper absorption.
20mg, 40mg, 60mg, 80mg capsules; 20mg/mL injection (IM)
Capsules: 20mg, 40mg, 60mg, 80mg; IM injection: 20mg/mL
Category C
D2 antagonist; potent 5-HT2A antagonist; some serotonin-norepinephrine reuptake inhibition; 5-HT1A partial agonism.
Slow taper, with food. ECG check if cardiac history.
Lower metabolic burden than olanzapine/quetiapine but distinctive cardiac considerations. Tardive risk applies to all dopamine antagonists.
2-5 days
1-2 weeks
2-4 weeks
Tardive symptoms can emerge weeks-to-months after taper
Toxicity
QT prolongation (highest among atypicals), sedation, akathisia, EPS, NMS, rash (Stevens-Johnson rare), tardive dyskinesia.
Pharmacokinetics
Hepatic via aldehyde oxidase (major) and CYP3A4 (minor).
>99%
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