Ziprasidone Dosage

This dosage information may not include all the information needed to use Ziprasidone safely and effectively. See additional information for Ziprasidone.

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Schizophrenia

Injection:
10 mg IM every 2 hours or 20 mg every 4 hours as needed
Maximum dose: 40 mg per day
There are no data on the IM administration of ziprasidone for greater than 3 consecutive days.

Oral:
Initial dose: 20 mg twice a day with food. If clinically necessary, initial dosage may be adjusted at intervals of not less than 2 days up to 80 mg twice a day.
Maximum dose: 100 mg twice a day

One study has reported that oral ziprasidone should be taken with food and that a meal equal to or greater than 500 kcal, irrespective of fat content, is required for optimal and reproducible bioavailability of the administered dose.

Usual Adult Dose for Autism

Injection:
10 mg IM every 2 hours or 20 mg every 4 hours as needed
Maximum dose: 40 mg per day
There are no data on the IM administration of ziprasidone for greater than 3 consecutive days.

Oral:
Initial dose: 20 mg twice a day with food. If clinically necessary, initial dosage may be adjusted at intervals of not less than 2 days up to 80 mg twice a day.
Maximum dose: 100 mg twice a day

One study has reported that oral ziprasidone should be taken with food and that a meal equal to or greater than 500 kcal, irrespective of fat content, is required for optimal and reproducible bioavailability of the administered dose.

Usual Adult Dose for Bipolar Disorder

Oral:
Acute Treatment of Manic or Mixed Episodes:
Initial dose: 40 mg twice a day with food. The dose should then be increased to 60 mg or 80 mg twice a day on the second day of treatment. The dose should then be adjusted on the basis of toleration and efficacy within the 40 mg to 80 mg twice a day range.

Maintenance Treatment (as an adjunct to lithium or valproate):
Continue treatment at the same dose on which the patient was initially stabilized, within the range of 40 mg to 80 mg twice daily with food. Patients should be periodically reassessed to determine the need for maintenance treatment.

One study has reported that oral ziprasidone should be taken with food and that a meal equal to or greater than 500 kcal, irrespective of fat content, is required for optimal and reproducible bioavailability of the administered dose.

Usual Pediatric Dose for Tourette's Syndrome

Not FDA approved:
Tourette's syndrome: 5 to 40 mg orally per day

Usual Pediatric Dose for Bipolar Disorder

Not FDA Approved:
Note: In June 2009, an FDA advisory panel advised that ziprasidone is effective in patients 10 to 17 years of age for the treatment of mixed and manic episodes of bipolar disorder, but did not conclude that it was safe due to large number of subjects lost to follow-up and ambiguity within QTc prolongation data; limited data available.

Children and Adolescents 10 to 17 years:
Initial dose: 20 mg/day; titrate dose upwards as tolerated, using twice daily dosing over a 2 week period to the weight-based target range: 60 to 80 mg/day (45 kg or less) divided into twice daily doses or 120 to 160 mg/day (greater than 45 kg) divided into twice daily doses.
Alternate dosing: An open-label, 8 week study of 21 patients [6 to 17 years (mean: 10.3 years)] with bipolar disorder and comorbid conditions (ADHD, depression, conduct disorder) used the following weight-based dosing regimen:
Initial dose: 1 mg/kg/day divided twice daily; increase to 1.5 mg/kg/day divided twice daily by Week 2 and increase to 2 mg/kg/day divided twice daily by Week 3 if tolerated; maximum dose: 160 mg/day; Note: Only 14 of the 21 patients completed the study; five dropped out due to lack of efficacy; two dropped out due to adverse reactions; patients experienced a high incidence of sedation (46%) and headaches (38%).

Usual Pediatric Dose for Autism

Not FDA Approved:
Autism and PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified) irritability: Children and Adolescents 8 to 20 years: Limited data available; dose not established. Reported final dose range: 20 to 160 mg/day divided twice daily
A prospective, open-labeled study of 12 patients (12 to 18 years) used the following individually titrated doses:
Patient weight 35 kg or less: Initial: 20 mg every other day given at bedtime for 2 doses; then increase dose in weekly increments based on clinical response and tolerability: Week 1: 10 mg twice daily (20 mg/day); Week 2: 20 mg twice daily (40 mg/day); Week 3: 40 mg twice daily (80 mg/day); Week 4: 80 mg twice daily (160 mg/day)
Patient weight greater than 35 kg: Initial: 20 mg/day at bedtime for 3 doses; then increase dose in weekly increments based on clinical response and tolerability: Week 1: 20 mg twice daily (40 mg/day); Week 2: 40 mg twice daily (80 mg/day); Week 4: 80 mg twice daily (160 mg/day)
A case series of 12 patients (8 to 20 years) initiated with 20 mg/day given at bedtime and then increased by 10 to 20 mg/week divided twice daily based on clinical response and tolerability; final ziprasidone dosage ranged between 20 to 120 mg/day (mean: 60 mg/day) divided twice daily.

Usual Pediatric Dose for Schizophrenia

Not FDA Approved:
Acute agitation (schizophrenia): Children and Adolescents: Limited information available; dose not established
5 to 11 years: 10 mg intramuscularly once.
12 years or older : 10 to 20 mg intramuscularly once. Note: One study (n=59; age range: 5 to 19 years) reported that 69% of 20 mg doses surpassed the desired calming therapeutic effect and caused varying degrees of sedation (4% of patients were unable to be aroused).

Renal Dose Adjustments

Dose adjustments of oral ziprasidone are generally not necessary for patients with renal dysfunction. Injectable ziprasidone should be used with caution in patients with renal dysfunction as the excipient cyclodextran is eliminated via renal filtration.

Liver Dose Adjustments

No adjustment recommended

Precautions

Ziprasidone is not approved by the FDA for use in the treatment of behavioral disorders in elderly patients with dementia. The incidence of mortality has been reported to be 1.6 to 1.7 times higher with the use of atypical (second generation) antipsychotics compared to the use of placebo in this patient population. The cause of death in most cases was reported to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Although ziprasidone was not included in these studies, the consistent findings across all three relevant chemical classes support the opinion that these findings are likely to be applicable to all atypical antipsychotic agents.

When choosing a treatment plan for a patient with schizophrenia, ziprasidone's greater capacity to prolong the QT/QTc interval, in relation to other antipsychotic agents, should be considered by the clinician.

Because ziprasidone prolongs the QT interval, it is contraindicated in patients with a known history of QT prolongation (including congenital long QT syndrome), with recent acute myocardial infarction, or with uncompensated heart failure.

Patients being considered for ziprasidone treatment that are at risk of significant electrolyte disturbances should have baseline serum potassium and magnesium measurements. Low serum potassium and magnesium should be repleted before proceeding with treatment. Patients who are started on diuretics during ziprasidone therapy need periodic monitoring of serum potassium and magnesium.

The possibility of a suicide attempt is inherent in psychotic illness or bipolar disorder, and close supervision of high risk patients should accompany drug therapy. Prescriptions for ziprasidone should be written for the smallest quantity of capsules consistent with good patient management in order to reduce the risk of overdose.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

No dosage recommended

Other Comments

To ensure the use of the lowest effective dose for the treatment of schizophrenia, patients should be observed for signs of improvement over a period of several weeks prior to initiating an upward dosage adjustment.

Short-term placebo-controlled trials have reported ziprasidone in the dosage range of 20 to 100 mg twice a day to be efficacious in the treatment of schizophrenia. However, dosages greater than 80 mg twice a day are generally not recommended.

A placebo-controlled study reported ziprasidone in the dosage range of 20 to 80 mg twice a day to be effective in the treatment of schizophrenia up to 52-weeks. Patients should be clinically assessed on a periodic basis to evaluate efficacy of maintenance therapy and appropriateness of dosage.

There are no data to support the use of ziprasidone for a duration of greater than 3 weeks in the treatment of mania associated with bipolar disorder.

There are no data on the safety and efficacy of doses greater than 100 mg twice a day.

Injectable ziprasidone is intended for intramuscular administration only.

In patients requiring long-term therapy, oral ziprasidone should replace intramuscular administration as soon as possible.

Development of hyperglycemia and/or diabetes mellitus is common in patients treated with atypical antipsychotics. Periodic monitoring of fasting plasma glucose is recommended in patients receiving ziprasidone.

Hide
(web1)