Ziprasidone IM
GEODON IM
Pronunciation: zi-PRAY-si-doen
“Geode Don’s Zipper”
Spooky mascot → antipsychotic
DRESS syndrome
QT prolongation
What it isIM D2 and 5-HT2A antagonist (GEODON IM, 2002) with broad receptor activity; acute agitation in schizophrenia.
Why this oneIM half-life 2–5 h (shorter than oral) makes it useful when a short-acting atypical is wanted.
What limits itQTc is the class concern (oral ziprasidone carries the largest atypical QTc effect); avoid stacking with other QT-prolongers.
FDA-approved for
- acute agitation (schizophrenia) (2002)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Acute agitation in schizophrenia (intramuscular) | Adults | 10–20 mg IM | 40 mg/day |
Renal IM: use with caution in renal impairment (cyclodextrin excipient cleared by renal filtration); oral: no adjustment needed
Hepatic Undefined for IM (not evaluated); hepatic impairment increases oral ziprasidone AUC
IM 10 mg may be given every 2 h; 20 mg every 4 h; max 40 mg/day
Instructions
- Intramuscular use only; do not administer intravenously
- Reconstitute vial with 1.2 mL Sterile Water for Injection (20 mg/mL)
- Replace IM with oral ziprasidone as soon as possible; IM not studied beyond 3 consecutive days
Available strengths
- inj 20 mg/mL (20 mg vial)
Contraindications
- Known history of QT prolongation (including congenital long QT syndrome)
- Recent acute myocardial infarction
- Uncompensated heart failure
- Concomitant use with other drugs that have demonstrated QT prolongation
- Concomitant use of monoamine oxidase inhibitors (MAOIs), or use within 14 days of stopping MAOIs (including linezolid and intravenous methylene blue)
Cautions
- QT prolongation/risk of sudden death
- Cerebrovascular reactions in elderly with dementia
- Serotonin syndrome
- Neuroleptic malignant syndrome
- Severe cutaneous adverse reactions (DRESS)
- Tardive dyskinesia
- Metabolic changes
- Orthostatic hypotension
- Leukopenia/neutropenia/agranulocytosis
- Seizures
- Priapism
Adverse reactions
- Headache
- Nausea
- Somnolence
- Dizziness
- Injection site pain
- Postural hypotension
Pregnancy Third-trimester exposure risks neonatal extrapyramidal/withdrawal symptoms
Lactation Present in human milk; monitor breastfed infant for sedation, irritability, poor feeding, and extrapyramidal symptoms
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 20 mg/mL | inj | per unit | $21.81/ea | not offered |
Other forms: Ziprasidone (GEODON)
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Classes and tags
Clinical profile
Serotonin and MAOI
Provisional washout figures
Elevating mechanismWeak/borderline SRI
Exposure dependenceDose/exposure dependent; clinical relevance mainly with MAO-A inhibition
Evidence confidenceModerate
InterpretationPossible weak SRI signal, but strong 5-HT2A antagonism and no established Gillman-type toxicity interaction.
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Memory aids: interaction avatars
