Why We Would and Wouldn’t Use Ziprasidone

Why we would and wouldn't use ziprasidone

Looking at the adverse effect profile of second-generation antipsychotics is critical to medication selection in clinical practice. You should definitely know the general list of adverse effects of antipsychotics (i.e. EPS, metabolic syndrome, QTc prolongation, etc.). What you should also be aware of is the subtleties for each individual agent. For ziprasidone, I remember two important clinical pearls with regards to its adverse effect profile compared to other antipsychotics and also two reasons why we would and wouldn’t use ziprasidone.

Ziprasidone rates as one of the highest risk antipsychotics in patients who have QTc prolongation. In a patient who is at risk for this complication, we would want to avoid this medication. Drugs like amiodarone, levofloxacin, citalopram, and macrolide antibiotics are a few classic examples of medications that can exacerbate QTc prolongation. In addition to drug risk factors, recall that past medical history and electrolyte imbalances may also increase the risk for cardiac complications.

While high on the QTc prolongation risk, ziprasidone tends to run low on the metabolic syndrome risk. If you have an obese patient who already has challenges with hyperlipidemia, weight gain, or hyperglycemia, ziprasidone may be a lower risk agent for this concern. Recall that drugs like olanzapine and clozapine run the highest risk.

So there you have my two reasons why we would and wouldn’t use ziprasidone in clinical practice. Did I miss anything? Leave a comment below!

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1 Comment

  1. Jeff Gray

    Ziprasidone is unique in one additional way. Adequate systemic absorption is reached when the medication is administered with >500 calories. For some patients, an administration timed calorie goal is only a counseling point. However, others may not be able to consistently consume a high calorie meal for optimized absorption. Proceed with caution in consistently low calorie consumers such as geriatric patients, skilled nursing residents, patients with medically restricted caloric goals, etc. Certainly a need for ongoing disease monitoring is warranted in those patients.


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Written By Eric Christianson

January 6, 2021

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