drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.vecuroniumMonitor Closely (3)vecuronium decreases levels of ziprasidone by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. vecuronium decreases levels of ziprasidone by pharmacodynamic antagonism. Use Caution/Monitor. ziprasidone increases effects of vecuronium by pharmacodynamic synergism. Use Caution/Monitor. Additive anticholinergic effects, possible hypoglycemia.vemurafenibSerious - Use Alternative (1)vemurafenib and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.venlafaxineMonitor Closely (2)venlafaxine, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction). venlafaxine and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.verapamilMinor (1)verapamil will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.vilanterol/fluticasone furoate inhaledSerious - Use Alternative (1)ziprasidone increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.vilazodoneMonitor Closely (1)vilazodone, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).voclosporinMonitor Closely (1)voclosporin, ziprasidone. Either increases effects of the other by QTc interval. Use Caution/Monitor.voriconazoleMonitor Closely (1)voriconazole and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.Minor (1)voriconazole will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.vorinostatSerious - Use Alternative (1)vorinostat and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.xylometazolineMonitor Closely (1)ziprasidone increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbineMonitor Closely (1)ziprasidone increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.zafirlukastMinor (1)zafirlukast will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ziconotideMonitor Closely (1)ziprasidone and ziconotide both increase sedation. Use Caution/Monitor.zolmitriptanMonitor Closely (1)zolmitriptan, ziprasidone. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).zotepineMonitor Closely (2)ziprasidone and zotepine both increase antidopaminergic effects, including extrapyramidal symptoms and neuroleptic malignant syndrome. Use Caution/Monitor. ziprasidone and zotepine both increase sedation. Use Caution/Monitor. >10% Somnolence (11-15%) Headache (11%) Nausea (4-12%) Extrapyramidal symptoms (2-31%) Dizziness (3-16%) 1-10% Respiratory disorders (1-8%) Constipation (2-9%) Dyspepsia (1-8%) Rash (4-5%) Tachycardia (2%) Hypoesthesia (2%) Priapism (1%) Orthostatic hypotension (5%) Xerostomia (1-5%) Anorexia (2%) Myalgia (2%) Rhinitis (1-4%) Cough (3%) <1% Syncope Seizures Frequency Not Defined Prolongation of QT interval Neuroleptic malignant syndrome (NMS) Hyperprolactinemia Drug reaction with eosinophilia and systemic syntoms Postmarketing reports Stevens-Johnson syndrome Black Box Warnings Not approved for dementia-related psychosis; patients with dementia-related psychosis who are treated with antipsychotic drugs are at increased risk of death, as shown in short-term controlled trials; deaths in these trials appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature Not approved for the treatment of dementia-related psychosisContraindications Documented hypersensitivity Any drugs or conditions that prolong QT interval Recent acute myocardial infarction Uncompensated heart failure Cautions Seizure disorders; may cause hypotension, EPS, somnolence, and sensory instability, which could lead to falls and, consequently, fractures or other injuries; for patients with diseases, conditions, or medications that could exacerbate these effects, complete fall risk assessments when initiating antipsychotic treatment and recurrently for patients on long-term antipsychotic therapy Atypical antipsychotics have been associated with metabolic changes (eg, hyperglycemia, dyslipidemia, and body weight gain) that may increase cardiovascular/cerebrovascular risk Hyperglycemia may occur and in some cases may be extreme, resulting in ketoacidosis, hyperosmolar coma, or death; monitor blood glucose of high-risk patients Neuroleptic malignant syndrome reported with antipsychotic drugs Tardive dyskinesia, acute dystonic reactions, pseudoparkinsonism, or akathisia may develop acutely or chronically Discontinue if rash develops without an identified cause Drug reaction with eosinophilia and systemic symptoms (DRESS) reported; DRESS consists of combination of three or more of the following: cutaneous reaction (such as rash or exfoliative dermatitis), eosinophilia, fever, lymphadenopathy and one or more systemic complications such as hepatitis, nephritis, pneumonitis, myocarditis, and pericarditis; DRESS is sometimes fatal; discontinue therapy if DRESS suspected Cutaneous adverse reactions, such as Stevens-Johnson syndrome, reported; severe cutaneous adverse reactions are sometimes fatal; discontinue therapy if suspected Rare cases of priapism reported FDA warning regarding off-label use for dementia in elderly (see Black Box Warnings) May cause orthostatic hypotension Suicide attempt is inherent in psychotic illness or bipolar disorder, close supervision of high-risk patients should accompany drug therapy Dopamine2 antagonists may elevate prolactin levels; long-standing hyperprolactinemia when associated with hypogonadism may lead to decreased bone density Leukopenia/neutropenia and agranulocytosis reported; possible risk factors for leukopenia/neutropenia include preexisting low white blood cell (WBC) count and history of drug-induced leukopenia/neutropenia If patient has history of clinically significant low WBC count or drug-induced leukopenia/neutropenia, monitor complete blood count (CBC) frequently during first few months of therapy; discontinue drug at first sign of clinically significant WBC decline <1000/μL in absence of other causative factors, and continue monitoring WBC count until recovery Antipsychotic agents have been associated with esophageal dysmotility and aspiration; use caution in patients at risk of pneumonia May cause QTc prolongation, which has been associated with development of malignant ventricular arrhythmias (torsade de pointes) and sudden death; discontinue therapy in patients with persistent QTc intervals >500 msec; avoid hypokalemia or hypomagnesemia Moderate to highly sedative; use caution when required to operate heavy machinery May cause core body temperature regulation impairment; use caution with heat exposure, strenuous exercise, dehydration, or taking medications with anticholinergic effects Make electrolyte imbalance corrections, especially hypomagnesemia or hypokalemia before and throughout therapy Use with caution in hepatic impairment Pregnancy There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to atypical antipsychotics, during pregnancy; healthcare providers are encouraged to register patients by contacting the National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or online at http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry Neonates exposed to antipsychotic drugs, during third trimester are at risk for extrapyramidal and/or withdrawal symptoms, following delivery; overall available data from published epidemiologic studies of pregnant women have not established a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes; there are risks to mother associated with untreated schizophrenia or bipolar I disorder and with exposure to antipsychotics, during pregnancy There is risk to the mother from untreated schizophrenia or bipolar I disorder, including increased risk of relapse, hospitalization, and suicide Schizophrenia and bipolar I disorder are associated with increased adverse perinatal outcomes, including preterm birth; it is not known if this is a direct result of illness or other comorbid factors Extrapyramidal and/or withdrawal symptoms, including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorder have been reported in neonates exposed to drug, during third trimester of pregnancy; these symptoms have varied in severity; monitor neonates for extrapyramidal and/or withdrawal symptoms and manage symptoms appropriately; some neonates recovered within hours or days without specific treatment; others required prolonged hospitalization Animal data In animal studies, drug administration to pregnant rats and rabbits during organogenesis caused developmental toxicity at doses similar to recommended human doses, and was teratogenic in rabbits at 3 times maximum recommended human dose (MRHD); rats exposed to drug during gestation and lactation exhibited increased perinatal pup mortality and delayed neurobehavioral and functional development of offspring at doses less than or similar to human therapeutic doses Reproductive potential Females: Based on pharmacologic action of ziprasidone (D2 antagonism), treatment may result in an increase in serum prolactin levels, which may lead to a reversible reduction in fertility in females of reproductive potential Lactation Limited data from a published case report indicate the presence of drug in human milk; although there are no reports of adverse effects on a breastfed infant exposed to drug via breast milk, there are reports of excess sedation, irritability, poor feeding, and extrapyramidal symptoms (tremors and abnormal muscle movements) in infants exposed to other atypical antipsychotics through breast milk There is no information on effects of drug on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and any potential adverse effects on breastfed child from drug or from mother’s underlying condition Infants exposed to drug should be monitored for excess sedation, irritability, poor feeding, and extrapyramidal symptoms (tremors and abnormal muscle movements)Pregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Acts as antagonist at dopamine D2 and serotonin type 1 and 2 (5HT1D, 5HT2A) receptors; acts as agonist at serotonin 5HT1A receptor; moderately inhibits reuptake of norepinephrine and serotonin; has alpha-blocking and antihistaminic activity Absorption Bioavailability: 60% (PO); 100% (IM) Peak plasma time: 6-8 hr (PO); ≤60 min (IM) Distribution Protein bound: 99% Vd: 1.5 L/kg Metabolism Metabolized in liver by CYP3A4 (major) and CYP1A2 (minor) Elimination Half-life: 7 hr (PO); 2-5 hr (IM) Total body clearance: 7.5 mL/min/kg Excretion: Feces (66%), urine (20%) Oral Administration Take capsules whole; do not open, crush, or chew the capsules Take with food for optimal absorption; in the presence of food, absorption increases twofold BRAND FORM. UNIT PRICE PILL IMAGE ziprasidone oral- 40 mg capsuleziprasidone oral- 20 mg capsuleziprasidone oral- 80 mg capsuleziprasidone oral- 60 mg capsuleziprasidone oral- 40 mg capsuleziprasidone oral- 60 mg capsuleziprasidone oral- 20 mg capsuleziprasidone oral- 80 mg capsuleziprasidone oral- 40 mg capsuleziprasidone oral- 80 mg capsuleziprasidone oral- 60 mg capsuleziprasidone oral- 80 mg capsuleziprasidone oral- 60 mg capsuleziprasidone oral- 40 mg capsuleziprasidone oral- 20 mg capsuleziprasidone oral- 20 mg capsuleziprasidone oral- 80 mg capsuleziprasidone oral- 20 mg capsuleziprasidone oral- 60 mg capsuleziprasidone oral- 60 mg capsuleziprasidone oral- 40 mg capsuleziprasidone oral- 80 mg capsuleziprasidone oral- 40 mg capsuleziprasidone oral- 20 mg capsuleGeodon oral- 80 mg capsuleGeodon oral- 60 mg capsuleGeodon oral- 20 mg capsuleGeodon oral- 40 mg capsuleCopyright © 2010 First DataBank, Inc.Print Patient Educationziprasidone oral ZIPRASIDONE - ORAL (zi-PRAS-i-done) COMMON BRAND NAME(S): Geodon WARNING: There may be a slightly increased risk of serious, possibly fatal side effects (such as stroke, heart failure, fast/irregular heartbeat, pneumonia) when this medication is used by older adults with dementia. This medication is not approved for the treatment of dementia-related behavior problems. Discuss the risks and benefits of this medication, as well as other effective and possibly safer treatments for dementia-related behavior problems, with the doctor.If you are using ziprasidone in combination with other medication to treat depression, also carefully read the drug information for the other medication. USES: This medication is used to treat certain mental/mood disorders (schizophrenia, bipolar disorder). This medication can decrease hallucinations and help you to think more clearly and positively about yourself, feel less agitated, and take a more active part in everyday life.Ziprasidone belongs to a class of drugs called atypical antipsychotics. It works by helping to restore the balance of certain natural substances in the brain. HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start taking ziprasidone and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with food as directed by your doctor,