Ziprasidone Side Effects

It is possible that some side effects of ziprasidone may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to ziprasidone: oral capsule

As well as its needed effects, ziprasidone may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking ziprasidone, check with your doctor immediately:

More common
  • Cough
  • difficulty with speaking
  • drooling
  • fear or nervousness
  • fever
  • inability to sit still
  • loss of balance control
  • muscle trembling, jerking, or stiffness
  • need to keep moving
  • restlessness
  • shuffling walk
  • sneezing
  • sore throat
  • stiffness of the limbs
  • twisting movements of the body
  • uncontrolled movements, especially of the face, neck, and back
Less common
  • Blurred vision
  • body aches or pain
  • chest pain
  • congestion
  • dizziness
  • fast, pounding, or irregular heartbeat or pulse
  • headache
  • hoarseness
  • nervousness
  • pounding in the ears
  • runny nose
  • slow or fast heartbeat
  • swelling of the tongue
  • tender, swollen glands in the neck
  • trouble with swallowing
  • voice changes
  • Fainting or feeling faint
  • feeling faint upon standing
  • persistent, painful erection
  • seizures
Incidence not known
  • Inability to move the eyes
  • increased blinking or spasms of the eyelid
  • sticking out of tongue
  • trouble with breathing, speaking, or swallowing
  • uncontrolled twisting movements of the neck, trunk, arms, or legs
  • unusual facial expressions

If any of the following symptoms of overdose occur while taking ziprasidone, get emergency help immediately:

Symptoms of overdose
  • Drowsiness
  • shakiness in the legs, arms, hands, or feet
  • sleepiness
  • slurred speech
  • trembling or shaking of the hands or feet

Some ziprasidone side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common
  • Acid or sour stomach
  • belching
  • constipation
  • diarrhea
  • heartburn
  • indigestion
  • lack or loss of strength
  • nausea
  • rash
  • stomach discomfort, upset, or pain
  • weakness
  • weight gain
Less common
  • Blistering, crusting, irritation, itching, or reddening of the skin
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • change in vision
  • cracked, dry, or scaly skin
  • depression
  • difficulty with moving
  • dry mouth
  • increase in salivation
  • itching or reddening of the skin
  • joint pain
  • loss of appetite
  • muscle ache
  • muscle pains or stiffness
  • muscle tightness
  • stuffy nose
  • swelling
  • swollen joints
  • vomiting
  • weakness of the arms and legs
  • weight loss

For Healthcare Professionals

Applies to ziprasidone: intramuscular powder for injection, oral capsule

Nervous system

Nervous system side effects have frequently included extrapyramidal symptoms encompassing hypertonia, dystonia, dyskinesia, hypokinesia, tremor, paralysis, and twitching. Extrapyramidal side effects have been reported in 14% and 31% of patients with schizophrenia and bipolar mania, respectively, though no one effect occurred individually at an incidence greater than 10% in the bipolar mania trials. Headache (18%), somnolence (14% to 31%), dizziness/lightheadedness (8% to 16%), akathisia (8% to 10%), anxiety (5%), asthenia (5%), insomnia (3%), hypesthesia (2%), speech disorder (2%), agitation, hostility, paresthesia, confusion, vertigo, hyperkinesia, abnormal gait, oculogyric crisis, hypesthesia, ataxia, amnesia, cogwheel rigidity, delirium, hypotonia, akinesia, dysarthria, withdrawal syndrome, buccoglossal syndrome, choreoathetosis, diplopia, incoordination, and neuropathy have also been reported frequently. Paralysis has been reported infrequently. Myoclonus, nystagmus, torticollis, circumoral paresthesia, opisthotonos, increased reflexes, neuromalignant syndrome, and trismus have been reported rarely. Single cases of tardive dystonia and parkinsonism have been reported. Syncope, serotonin syndrome (alone or in combination with other serotonergic agents), and facial droop have been observed in postmarketing use.

Ziprasidone has been associated with improvement on cognitive test performance in patients in the early stages of schizophrenia.[Ref]

A 20-year-old male with a history of auditory hallucinations, paranoid delusions, flat affect, and social withdrawal, showed signs of mania following 7 days of ziprasidone therapy at a final dose of 80 mg once at bedtime. Symptoms resolved approximately 48 hours following discontinuation of ziprasidone therapy.

A 53-year-old male diagnosed with schizoaffective disorder at 12 years of age was admitted from the emergency room with a diagnosis of schizophrenia, paranoid type. The patient denied receiving pharmacological treatment in the previous 3 month time period. Ziprasidone therapy was initiated with 40 mg orally twice a day on Day 1 followed by a dosage adjustment to 80 mg twice a day on Day 2. The patient demonstrated notable torticollis and dystonic posturing of his left carpus approximately four hours following his sixth 80 mg dose. Palpitation of his musculature revealed spasm. The patient had normal lab values and was deemed to be without general medical conditions. Muscular contraction was relieved with injectable diphenhydramine. Ziprasidone was discontinued and the patient showed no signs of recurrence during a subsequent 24-hour observation period. Soon thereafter the patient left the facility against medical advice and without further pharmacologic treatment. The rapid increase in dosage may have contributed to the observed dystonia.

A 12-year-old male with a history of schizoaffective disorder was switched from risperidone orally 2 mg once a day (because of facial twitching) to ziprasidone orally 80 mg once a day. Approximately 8-weeks after initiation of ziprasidone therapy the patient presented to the emergency room as rigid, diaphoretic, tremulous, difficult to arouse, and with tactile fever, urinary incontinence, and incoherent speech. Ziprasidone was discontinued and the patient was treated for neuroleptic malignant syndrome (NMS). The patient was assessed approximately 2 months after the incident and was deemed to have made a full neurologic and physical recovery.

Five female patients with bipolar disorder receiving ziprasidone (80 to 160 mg/day) developed severe and abrupt akathisia following a dose reduction. In each case, akathisia resolved following treatment and/or discontinuation of ziprasidone.

Lower (worse) baseline scores predicted greater cognitive improvement. Change In cognitive performance was weakly related to change in symptom scores.[Ref]


Gastrointestinal side effects have frequently included nausea (10%), constipation (9%), dyspepsia (8%), diarrhea (5%), vomiting (5%), increased salivation (4%), dry mouth (4%), tongue edema (3%), dysphagia (2%), anorexia (2%), tooth disorder, abdominal pain, and dry mouth. Rectal hemorrhage has been reported infrequently. Gum hemorrhage, fecal impaction, hematemesis, leukoplakia of mouth, melena, and swollen tongue have also been reported.[Ref]


Collective data gathered from 17 placebo-controlled clinical studies (n=5106) involving the use of atypical antipsychotic agents for the treatment of behavioral disorders in the elderly patient with dementia showed a risk of death 1.6 to 1.7 times greater in the drug-treated patient than in the placebo-treated patient. The average length of duration for the trials was 10 weeks with the cause of death in the majority of cases, though not all, reported as 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. Ziprasidone is not approved by the FDA for use in the treatment of behavioral disorders in elderly patients with dementia.[Ref]

Respiratory side effects have frequently included respiratory tract infections (8%), rhinitis (4%), increased cough (3%), pharyngitis (3%), and dyspnea (2%). Pneumonia and epistaxis have also been reported. Hemoptysis and laryngismus have been reported rarely.[Ref]


The manufacturer reports the most common event associated with dropout in two short-term placebo-controlled studies involving patients receiving oral ziprasidone was rash (1%).[Ref]

Dermatologic side effects have frequently included rash (4%), fungal dermatitis (2%), furunculosis, and sweating. Maculopapular rash, urticaria, alopecia, eczema, exfoliative dermatitis, contact dermatitis, and vesiculobullous rash have also been reported.[Ref]


Ocular side effects have frequently included abnormal vision in up to 6% of patients. Conjunctivitis, dry eyes, blepharitis, cataract, and photophobia have also been reported. Eye hemorrhage, visual field defects, keratitis, and keratoconjunctivitis have been reported rarely.[Ref]


Cardiovascular side effects have frequently included tachycardia (2%), hypertension (3%), chest pain (3%), postural hypotension (1%), bradycardia, and vasodilation. Increase in QTc interval, angina pectoris, atrial fibrillation have also been reported. First degree AV block, bundle branch block, phlebitis, pulmonary embolus, cardiomegaly, cerebral infarct, cerebrovascular accident, deep thrombophlebitis, myocarditis, thrombophlebitis, and Torsade de Pointes have been reported rarely.[Ref]

In schizophrenia trials, oral ziprasidone was associated with a mean increase in heart rate of 1.4 beats per minute compared to a 0.2 beats per minute decrease in placebo patients.

Collective data gathered from 17 placebo-controlled clinical studies (n=5106) involving the use of atypical antipsychotic agents for the treatment of behavioral disorders in the elderly patient with dementia showed a risk of death 1.6 to 1.7 times greater in the drug-treated patient than in the placebo-treated patient. The average length of duration for the trials was 10 weeks with the cause of death in the majority of cases, though not all, reported as 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. Ziprasidone is not approved by the FDA for use in the treatment of behavioral disorders in elderly patients with dementia.[Ref]


Endocrine side effects have included hyperprolactinemia, hyperglycemia, and diabetes mellitus. Hypothyroidism, hyperthyroidism, thyroiditis, hypoglycemia, decreased glucose tolerance, hypoglycemic reaction, and ketosis have been reported rarely. A significant reduction in serum cholesterol and triglycerides has been reported in one study (n=37).[Ref]

Hyperprolactinemia in some patients may cause sexual dysfunction and menstrual irregularities. In addition, as many as one-third of human breast cancers may be prolactin-dependent in vitro.

Studies have demonstrated that patients receiving atypical antipsychotics (i.e., clozapine, risperidone, olanzapine, quetiapine, ziprasidone) are at an increased risk of developing hyperglycemia and/or diabetes mellitus.[Ref]


Musculoskeletal side effects have included myalgia (2%) and tenosynovitis (less than 1%). Myopathy has been reported rarely.[Ref]


A one year study reported clinically significant weight gain, as defined by an increase in body weight of greater than or equal to 7%, in 5% to 11% of ziprasidone recipients. However, median weight actually decreased from baseline by 1, 2, and 3 kg in recipients of ziprasidone 20 mg, 40 mg, and 80 mg twice daily, respectively.

Ziprasidone had a negligible effect on body weight in two short-term studies.

Hyperglycemia has been reported in patients treated with atypical antipsychotics. In some cases, the hyperglycemia has been extreme and associated with ketoacidosis or hyperosmolar coma and death. There have been a few reports of hyperglycemia and diabetes in patients treated with ziprasidone.

Assessment of the relationship between atypical antipsychotic use and glucose abnormalities is complicated by the possibility of an increased background risk of diabetes mellitus in patients with schizophrenia and the increasing incidence of diabetes mellitus in the general population. Epidemiological studies (which did not include ziprasidone) suggest an increased risk of treatment-emergent hyperglycemia-related adverse events in patients treated with the atypical antipsychotics included in the studies.[Ref]

Metabolic side effects have frequently included weight gain (10%). Increased transaminase, increased creatinine phosphokinase, increased alkaline phosphatase, increased lactic dehydrogenase, albuminuria, hypokalemia have also been reported. Increased BUN, increased creatinine, hyperlipemia, hypocholesteremia, hyperkalemia, hypochloremia, hyponatremia, hypoproteinemia, gout, hyperchloremia, hyperuricemia, hypocalcemia, hypomagnesemia, and respiratory alkalosis.[Ref]


Oncologic side effects have been reported in animal studies. These animal studies have revealed dose-related increases in the incidence of pituitary gland adenoma and carcinoma, and gland adenocarcinoma.[Ref]


A 32-year-old male with a history of schizophrenia reported unwanted penile erections lasting a duration of approximately 1 hour. The patient reported this effect starting approximately 10 weeks after initiation of ziprasidone therapy and occurring at a rate of approximately 3 episodes per week. The patient mentioned this adverse effect to his clinician at a regular office visit approximately 1-month later. The problem resolved without recurrence following discontinuation of ziprasidone therapy.[Ref]

Genitourinary side effects have included impotence, abnormal ejaculation, amenorrhea, hematuria, menorrhagia, female lactation, polyuria, urinary retention, metrorrhagia, male sexual dysfunction, anorgasmia, dysmenorrhea, and glycosuria. Gynecomastia, vaginal hemorrhage, nocturia, oliguria, female sexual dysfunction, and uterine hemorrhage have been reported rarely. Enuresis, urinary incontinence, and priapism have also been reported.[Ref]


Hematologic side effects have infrequently included anemia, ecchymosis, leukocytosis, leukopenia, eosinophilia, and lymphadenopathy. Thrombocytopenia, hypochromic anemia, lymphocytosis, monocytosis, basophilia, lymphedema, polycythemia, thrombocythemia, neutropenia, and agranulocytosis have been reported rarely.[Ref]


Hepatic side effects have rarely included jaundice, increased gamma glutamyl transpeptidase, cholestatic jaundice, hepatitis, hepatomegaly, and fatty liver deposit.[Ref]


Hypersensitivity side effects have rarely included allergic reactions (such as allergic dermatitis, angioedema, orofacial edema, and urticaria) and rash.[Ref]


Other side effects have frequently included accidental injury (4%), flu syndrome, fever, accidental fall, face edema, chills, photosensitivity reaction, flank pain, hypothermia, peripheral edema, thirst, dehydration, tinnitus, and motor vehicle accident.[Ref]


Psychiatric side effects reported in the short-term trials with intramuscular ziprasidone have included personality disorder and psychosis. Mania/hypomania and depression have also been reported rarely.[Ref]


Local side effects associated with intramuscular ziprasidone have frequently included pain at the injection site.[Ref]


1. Nolan BP "Mania Associated With Initiation of Ziprasidone." J Clin Psychiatry 64 (2003): 336

2. Davidson M, Galderisi S, Weiser M, et al. "Cognitive Effects of Antipsychotic Drugs in First-Episode Schizophrenia and Schizophreniform Disorder: A Randomized, Open-Label Clinical Trial (EUFEST)." Am J Psychiatry (2009):

3. Rosenquist KJ, Walker SS, Ghaemi SN "Tardive Dyskinesia and Ziprasidone." Am J Psychiatry 159 (2002): 1436

4. Oral ET, Altinbas K, Demirkiran S "Sudden akathisia after a ziprasidone dose reduction." Am J Psychiatry 163 (2006): 546

5. Leibold J, Patel V, Hasan RA "Neuroleptic malignant syndrome associated with ziprasidone in an adolescent." Clin Ther 26 (2004): 1105-8

6. Mason MN, Johnson CE, Piasecki M "Ziprasidone-induced acute dystonia." Am J Psychiatry 162 (2005): 625-6

7. "Product Information. Geodon (ziprasidone)." Pfizer US Pharmaceuticals, New York, NY.

8. Papapetropoulos S, Wheeler S, Singer C "Tardive dystonia associated with ziprasidone." Am J Psychiatry 162 (2005): 2191

9. Bilal L, Tsai C, Gasper JJ, Ndlela JC "Parkinsonism with intramuscular ziprasidone." Am J Psychiatry 162 (2005): 2392-3

10. Dew RE, Hughes D "Acute Dystonic Reaction With Moderate-Dose Ziprasidone." J Clin Psychopharmacol 24 (2004): 563-564

11. Murty RG, Mistry SG, Chacko RC "Neuroleptic malignant syndrome with ziprasidone." J Clin Psychopharmacol 22 (2002): 624-6

12. Keck ME, Muller MB, Binder EB, Sonntag A, Holsboer F "Ziprasidone-Related Tardive Dyskinesia." Am J Psychiatry 161 (2004): 175-176

13. FDA. U.S. Food and Drug Admiinistration. Center for Drug Evaluation and Research "FDA Public Health Advisory. Deaths and antipsychotics in elderly patients with behavioral disturbances. Available from: URL:" ([2005 Apr 11]):

14. Glassman AH, Bigger JT Jr "Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death." Am J Psychiatry 158 (2001): 1774-82

15. Henderson DC, Cagliero E, Copeland PM, et al. "Elevated hemoglobin A1c as a possible indicator of diabetes mellitus and diabetic ketoacidosis in schizophrenia patients receiving atypical antipsychotics." J Clin Psychiatry 68 (2007): 533-41

16. Melkersson K, Dahl ML "Adverse metabolic effects associated with atypical antipsychotics : literature review and clinical implications." Drugs 64 (2004): 701-23

17. Gianfrancesco F, Pesa J, Wang RH, Nasrallah H "Assessment of antipsychotic-related risk of diabetes mellitus in a Medicaid psychosis population: Sensitivity to study design." Am J Health Syst Pharm 63 (2006): 431-41

18. Sernyak MJ, Gulanski B, Rosenheck R "Undiagnosed hyperglycemia in patients treated with atypical antipsychotics." J Clin Psychiatry 66 (2005): 1463-7

19. Sanchez-Barranco P "New Onset of Diabetes Mellitus With Ziprasidone: A Case Report." J Clin Psychiatry 66 (2005): 268-269

20. Lusskin SI, Cancro R, Chuang L, Jacobson J "Prolactin elevation with ziprasidone." Am J Psychiatry 161 (2004): 1925

21. Kingsbury SJ, Fayek M, Trufasiu D, Zada J, Simpson GM "The apparent effects of ziprasidone on plasma lipids and glucose." J Clin Psychiatry 62 (2001): 347-9

22. Gunasekara NS, Spencer CM, Keating GM "Ziprasidone: a review of its use in schizophrenia and schizoaffective disorder." Drugs 62 (2002): 1217-51

23. Jaworowski S, Hauser S, Mergui J, Hirsch H "Ziprasidone and weight gain." Clin Neuropharmacol 27 (2004): 99-100

24. Mago R, Chism LM, Pinninti NR, Certa K "Urinary retention associated with ziprasidone: a case report." J Clin Psychiatry 69 (2008): 499-500

25. Reeves RR, Mack JE "Priapism associated with two atypical antipsychotic agents." Pharmacotherapy 22 (2002): 1070-3

26. Reeves RR, Kimble R "Prolonged erections associated with ziprasidone treatment: a case report." J Clin Psychiatry 64 (2003): 97-8

27. Kaptsan A, Dwolatzky T, Lerner V "Ziprasidone-associated depressive state in schizophrenic patients." Clin Neuropharmacol 30 (2007): 357-61

28. Keating AM, Aoun SL, Dean CE "Ziprasidone-Associated Mania: A Review and Report of 2 Additional Cases." Clin Neuropharmacol 28 (2005): 83-86

29. Park YM, Lee SH, Lee HJ, Kim H, Lee KJ, Kang SG "Ziprasidone-associated mania in korean schizophrenic patient." J Clin Psychopharmacol 28 (2008): 711-2

30. Brook S "Intramuscular Ziprasidone: Moving Beyond the Conventional in the Treatment of Acute Agitation in Schizophrenia." J Clin Psychiatry 64(Supplement 19) (2003): 13-18

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.