Ziprasidone IM

SGA / Benzisothiazolyl·Psychiatry - Acute Calming & Sedation

Rapid control of acute agitation in schizophrenia

SGAZeldox IM20 mgS4TGA

Max Dose

40 mg/day

Half-life

2-5 h

QTc Risk

HIGH

Sedation

RAPID

Rapid Summary

Overview

Short-acting intramuscular formulation of Ziprasidone. Provides rapid sedation for acute agitation in schizophrenia/bipolar without the severe EPS risks of typical agents.

Maximum Dose

Max 40 mg/day (e.g., 20 mg BD).

Clinical Focus

High baseline risk of QTc prolongation. Limit use to a maximum of 3 consecutive days before switching to oral.

Bottom Line

Ziprasidone IM is an injectable atypical antipsychotic for acute agitation with low metabolic risk, but has the highest QTc prolongation risk of IM antipsychotics requiring ECG monitoring.

Formulation & Access

Brand Names

Zeldox IM

Parenteral

Vials (20 mg powder for reconstitution). MUST be injected deep IM. Never give IV.

Prescribing & PBS

Hospital psychiatric supply. S4.

Indications & Use

Primary

TGA

Rapid control of acute agitation in schizophrenia.

Clinical Place

Alternative to IM Olanzapine or Haloperidol when a patient is highly prone to EPS or when benzodiazepines are contraindicated.

Quick reference

Class & Role

SGA / Benzisothiazolyl — Short-acting intramuscular formulation of Ziprasidone.

Route / Formulation

Vials (20 mg powder for reconstitution). MUST be injected deep IM. Never give IV. (Zeldox IM)

Usual Dose & Max

IM 10-20 mg STAT. May repeat 10 mg after 2 hours, or 20 mg after 4 hours. Max 40 mg/day.

Key Indication Doses

Acute Agitation: IM 10-20 mg STAT. May repeat 10 mg after 2 hours, or 20 mg after 4 hours. Max 40 mg/day. Elderly / Frail: Max 10 mg STAT. Extreme caution due to orthostatic drops.

Best Uses

Ziprasidone IM is an injectable atypical antipsychotic for acute agitation with low metabolic risk, but has the highest QTc prolongation risk of IM antipsychotics requiring ECG monitoring.

Avoid / Cautions

Recent myocardial infarction, uncompensated heart failure, baseline QTc > 500 ms. Pregnancy Category C.

Key Risks

Cardiovascular: QTc prolongation. HIGH — Orthostatic hypotension, tachycardia. Neurological: Somnolence, dizziness, akathisia. Gastrointestinal: Nausea (food not required for the IM formulation, unlike the oral capsules).

Key Interactions

Avoid concurrent use of other QTc prolonging drugs (e.g., Droperidol, Amiodarone, Macrolides). Additive hypotension with antihypertensives.

Monitoring

Baseline ECG to measure QTc interval before administration if clinically feasible. Check BP for postural drops after injection. Keep patient seated or supine.

Clinical Pearl

IM Ziprasidone is exclusively a short-term bridge. Guidelines mandate capping its use at 3 consecutive days to prevent cumulative cardiovascular toxicity. Transition to oral therapy ASAP.

Access

Zeldox IM

Brand: Zeldox IM

Ziprasidone IM

SGA / Benzisothiazolyl·Psychiatry - Acute Calming & Sedation

Rapid control of acute agitation in schizophrenia

SGAZeldox IM20 mgS4TGA

Max Dose

40 mg/day

Half-life

2-5 h

QTc Risk

HIGH

Sedation

RAPID

Rapid Summary

Overview

Short-acting intramuscular formulation of Ziprasidone. Provides rapid sedation for acute agitation in schizophrenia/bipolar without the severe EPS risks of typical agents.

Maximum Dose

Max 40 mg/day (e.g., 20 mg BD).

Clinical Focus

High baseline risk of QTc prolongation. Limit use to a maximum of 3 consecutive days before switching to oral.

Bottom Line

Ziprasidone IM is an injectable atypical antipsychotic for acute agitation with low metabolic risk, but has the highest QTc prolongation risk of IM antipsychotics requiring ECG monitoring.

Formulation & Access

Brand Names

Zeldox IM

Parenteral

Vials (20 mg powder for reconstitution). MUST be injected deep IM. Never give IV.

Prescribing & PBS

Hospital psychiatric supply. S4.

Indications & Use

Primary

TGA

Rapid control of acute agitation in schizophrenia.

Clinical Place

Alternative to IM Olanzapine or Haloperidol when a patient is highly prone to EPS or when benzodiazepines are contraindicated.

Quick reference

Class & Role

SGA / Benzisothiazolyl — Short-acting intramuscular formulation of Ziprasidone.

Route / Formulation

Vials (20 mg powder for reconstitution). MUST be injected deep IM. Never give IV. (Zeldox IM)

Usual Dose & Max

IM 10-20 mg STAT. May repeat 10 mg after 2 hours, or 20 mg after 4 hours. Max 40 mg/day.

Key Indication Doses

Acute Agitation: IM 10-20 mg STAT. May repeat 10 mg after 2 hours, or 20 mg after 4 hours. Max 40 mg/day. Elderly / Frail: Max 10 mg STAT. Extreme caution due to orthostatic drops.

Best Uses

Ziprasidone IM is an injectable atypical antipsychotic for acute agitation with low metabolic risk, but has the highest QTc prolongation risk of IM antipsychotics requiring ECG monitoring.

Avoid / Cautions

Recent myocardial infarction, uncompensated heart failure, baseline QTc > 500 ms. Pregnancy Category C.

Key Risks

Key Interactions

Avoid concurrent use of other QTc prolonging drugs (e.g., Droperidol, Amiodarone, Macrolides). Additive hypotension with antihypertensives.

Monitoring

Baseline ECG to measure QTc interval before administration if clinically feasible. Check BP for postural drops after injection. Keep patient seated or supine.

Clinical Pearl

IM Ziprasidone is exclusively a short-term bridge. Guidelines mandate capping its use at 3 consecutive days to prevent cumulative cardiovascular toxicity. Transition to oral therapy ASAP.

Access

Zeldox IM

Brand: Zeldox IM