Here’s a case scenario where the clinical outcome may have hinged on taking ziprasidone with or without food.

KD is a 33-year-old male who was diagnosed with schizophrenia. Olanzapine and risperidone were the first antipsychotics that were tried to help alleviate the positive symptoms (hallucinations, delusions, etc.) of schizophrenia. Olanzapine led to a quick uptick in weight which was very concerning to KD. He was switched to risperidone from the olanzapine. Risperidone led to significant EPS symptoms that were too bothersome to continue with therapy.

The healthcare team elected to try ziprasidone next. KD initially had a reduction in the positive symptoms of schizophrenia with good tolerability. After a few months, however, it appeared that symptoms had returned back to baseline. The team was considering increasing the dose because of this regression.

Upon investigation and discussion with the patient, it was found that he had started a new job. Previously he was unemployed. The new job required him to be at work by 6 AM every morning. This caused a change in the way he took his ziprasidone. When he was unemployed, he would take it at about 9 AM in the morning when he had breakfast. With his new job, he was taking it at or before 6 AM. He is never really very hungry right in the morning and was taking it without food.

So would taking ziprasidone with or without food really make that much difference? In this case, it did and there is pharmacokinetic evidence to back it up. When patients consume approximately 500 calories or more with their dose of ziprasidone, it can increase drug concentrations up to 80%. That is a huge difference and certainly can be clinically significant.

It is critical to remind patients that taking ziprasidone with or without food can make a big impact on whether the drug works or not. Pay attention to when patients are taking their dose of ziprasidone, their clinical status, and if any life changes may alter the way they take their medications.

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