Atypical antipsychotic – indole derivative
ATC code: N05AE04 (Ziprasidone)
Brand names
Geodon, Ziprasidona Cinfa
An antagonist at dopamine D2 and serotonin 5-HT2A receptors with partial 5-HT1A agonism. Also moderate serotonin and noradrenaline reuptake inhibition (potential antidepressant component). Compared with other atypical antipsychotics, minimal metabolic profile – almost no weight gain, hyperglycemia, dyslipidemia (advantage in metabolic syndrome). Half-life 7 hours – twice-daily dosing.
Second line
Second-line for schizophrenia per 2020. Starting dose 20 mg twice daily, titrated to 40–80 mg twice daily. Advantage: minimal metabolic impact; preferred in patients with metabolic syndrome, obesity, diabetes. Huhn 2019 network meta-analysis showed lower efficacy than olanzapine and but better metabolic tolerability.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Ziprasidone is an antipsychotic. It is prescribed only for schizophrenia and bipolar disorder ( 2020 guidelines). For acute stress or emotional regulation, ziprasidone does not work: no clinical studies of such use exist, no evidence base supports it. The drug has severe side effects: substantial QT-interval prolongation (greater than most antipsychotics), and risk of DRESS syndrome, a severe skin reaction ( warning, 2014). If ziprasidone was prescribed for stress or emotional regulation, consider seeking a second opinion.
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Boxed warning
FDA boxed warning: increased mortality in elderly patients with dementia treated with atypical antipsychotics.
T3 use carries neonatal extrapyramidal and withdrawal risk.
Not used during lactation.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Ziprasidone is evaluated for the following indications with varying evidence strength: Schizophrenia (evidence tier A), Stress and anxiety (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Ziprasidone (≥ 1 in 100): Drowsiness, Dizziness, Dry mouth, Constipation, QT prolongation, Extrapyramidal disorders. See the Safety section for uncommon and serious reactions.
FDA category C. T3 use carries neonatal extrapyramidal and withdrawal risk.
Not used during lactation.
Ziprasidone is contraindicated in: Ziprasidone hypersensitivity; QT prolongation, congenital long QT syndrome; Acute MI, decompensated heart failure; Concomitant QT-prolonging drugs; Pregnancy and lactation. Full list in the Safety section.
FDA boxed warning: increased mortality in elderly patients with dementia treated with atypical antipsychotics.