Ziprasidone

SGA / Benzisothiazolyl·Psychiatry - Oral Antipsychotics

Schizophrenia, Bipolar I mania or mixed episodes

Authority requiredPBSSGAZeldox80 mg+2

Max Dose

160 mg/day

Half-life

7 h

QTc Risk

HIGH

Food

500 KCAL REQ.

Rapid Summary

Overview

Second-Generation Antipsychotic (SGA). Highly weight-neutral and non-sedating, but structurally infamous for dose-dependent QTc prolongation and strict caloric absorption requirements.

Maximum Dose

Max 160 mg/day (e.g., 80 mg BD).

Clinical Focus

Must be taken with a substantial meal (> 500 calories). If taken on an empty stomach, absorption drops by 50% and the patient will relapse into psychosis.

Bottom Line

Ziprasidone is an atypical antipsychotic with low metabolic risk, but carries the highest QTc prolongation risk of the atypicals and must be taken with food for adequate absorption.

Formulation & Access

Brand Names

Zeldox

Oral Routes

Capsules (20, 40, 60, 80 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Schizophrenia, Bipolar I mania or mixed episodes.

Clinical Place

Preferred for patients who suffer severe weight gain or dyslipidemia on Olanzapine/Quetiapine, provided they have a healthy heart.

Quick reference

Class & Role

SGA / Benzisothiazolyl — Second-Generation Antipsychotic (SGA).

Route / Formulation

Capsules (20, 40, 60, 80 mg). (Zeldox)

Usual Dose & Max

Start PO 40 mg BD WITH FOOD. Titrate to 80 mg BD. Max 160 mg/day.

Key Indication Doses

Schizophrenia / Bipolar Mania: Start PO 40 mg BD WITH FOOD. Titrate to 80 mg BD. Max 160 mg/day. Renal / Hepatic Impairment: No dose adjustment required in renal failure. Hepatic clearance is robust.

Best Uses

Ziprasidone is an atypical antipsychotic with low metabolic risk, but carries the highest QTc prolongation risk of the atypicals and must be taken with food for adequate absorption.

Avoid / Cautions

Recent myocardial infarction, uncompensated heart failure, baseline QTc > 500 ms, concurrent use of other QTc-prolonging drugs (e.g., Sotalol, Amiodarone, Macrolides). Pregnancy Category C.

Key Risks

Cardiovascular: QTc prolongation. Carries one of the highest baseline QTc prolongation risks of the oral SGAs. Torsades de Pointes risk. Neurological: Akathisia, extrapyramidal side effects (EPS), insomnia, dizziness. Metabolic: Excellent metabolic profile. Weight-neutral, lipid-neutral.

Key Interactions

Additive QTc prolongation with SSRIs, TCAs, and antiarrhythmics. CYP3A4 inhibitors (Ketoconazole) increase levels; inducers (Carbamazepine) drastically reduce levels.

Monitoring

Baseline and routine ECG to measure QTc interval. Monitor U&E (potassium/magnesium must be normal). Ensure the patient is actually eating a heavy meal with the dose.

Clinical Pearl

Ziprasidone is highly lipophilic. If a patient takes it with a piece of toast or a black coffee, it will pass through unabsorbed. It physically requires a ~500 kcal, fat-containing meal to dissolve and enter the blood.

Access

Authority requiredZeldox80 mg

Brand: Zeldox
PBS status: Authority required
Formulation: Capsules (20, 40, 60, 80 mg)

Ziprasidone

SGA / Benzisothiazolyl·Psychiatry - Oral Antipsychotics

Schizophrenia, Bipolar I mania or mixed episodes

Authority requiredPBSSGAZeldox80 mg+2

Max Dose

160 mg/day

Half-life

7 h

QTc Risk

HIGH

Food

500 KCAL REQ.

Rapid Summary

Overview

Second-Generation Antipsychotic (SGA). Highly weight-neutral and non-sedating, but structurally infamous for dose-dependent QTc prolongation and strict caloric absorption requirements.

Maximum Dose

Max 160 mg/day (e.g., 80 mg BD).

Clinical Focus

Must be taken with a substantial meal (> 500 calories). If taken on an empty stomach, absorption drops by 50% and the patient will relapse into psychosis.

Bottom Line

Ziprasidone is an atypical antipsychotic with low metabolic risk, but carries the highest QTc prolongation risk of the atypicals and must be taken with food for adequate absorption.

Formulation & Access

Brand Names

Zeldox

Oral Routes

Capsules (20, 40, 60, 80 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Schizophrenia, Bipolar I mania or mixed episodes.

Clinical Place

Preferred for patients who suffer severe weight gain or dyslipidemia on Olanzapine/Quetiapine, provided they have a healthy heart.

Quick reference

Class & Role

SGA / Benzisothiazolyl — Second-Generation Antipsychotic (SGA).

Route / Formulation

Capsules (20, 40, 60, 80 mg). (Zeldox)

Usual Dose & Max

Start PO 40 mg BD WITH FOOD. Titrate to 80 mg BD. Max 160 mg/day.

Key Indication Doses

Schizophrenia / Bipolar Mania: Start PO 40 mg BD WITH FOOD. Titrate to 80 mg BD. Max 160 mg/day. Renal / Hepatic Impairment: No dose adjustment required in renal failure. Hepatic clearance is robust.

Best Uses

Ziprasidone is an atypical antipsychotic with low metabolic risk, but carries the highest QTc prolongation risk of the atypicals and must be taken with food for adequate absorption.

Avoid / Cautions

Recent myocardial infarction, uncompensated heart failure, baseline QTc > 500 ms, concurrent use of other QTc-prolonging drugs (e.g., Sotalol, Amiodarone, Macrolides). Pregnancy Category C.

Key Risks

Key Interactions

Additive QTc prolongation with SSRIs, TCAs, and antiarrhythmics. CYP3A4 inhibitors (Ketoconazole) increase levels; inducers (Carbamazepine) drastically reduce levels.

Monitoring

Baseline and routine ECG to measure QTc interval. Monitor U&E (potassium/magnesium must be normal). Ensure the patient is actually eating a heavy meal with the dose.

Clinical Pearl

Access

Authority requiredZeldox80 mg

Brand: Zeldox
PBS status: Authority required
Formulation: Capsules (20, 40, 60, 80 mg)