Ziprasidone (Zeldox® and generic forms) belongs to a group of medications called “atypical antipsychotics” or “second-generation antipsychotics.”

What is this medication used for?

Ziprasidone was first developed to treat psychotic illnesses such as schizophrenia. It is not approved by Health Canada for use in children and adolescents.

However, when potential benefits outweigh risks, ziprasidone may be prescribed “off-label” for treatment of schizophrenia and other psychotic disorders, irritability associated with autism, bipolar disorder and Tourette syndrome. Learn more about off-label medication use: http://bit.ly/KMH-off-label-use

Tell your doctor or pharmacist if you:

• Have allergies or bad reactions to a medication
• Are lactose intolerant
• Take (or plan to take) other prescription or non-prescription medications, including natural medicines. Some medications interact with ziprasidone. Your doctor may adjust medication doses or monitor for side effects
• Have a history of low blood pressure, diabetes, kidney disease or kidney stones, blood or bone marrow problems, seizures
• Have a history (or family history) of diabetes, heart disease, arrhythmia or “familial long QT syndrome”
• Miss a period, are pregnant, breast-feeding or planning a pregnancy
• Use alcohol or drugs. Taking ziprasidone together with certain substances may cause a bad reaction. Learn more at www.DrugCocktails.ca

When will the medication start to work?

When treating symptoms of schizophrenia, it may take 3 to 6 weeks or longer before the benefits are noticeable. If you are taking this medication to help with symptoms of mood disturbances, you may notice some changes in the first 1 to 2 weeks. It can take up to 6 weeks to see the full benefits of the medication.

You (or your family members) may notice clearer thoughts, less moodiness, anger, irritability, or explosive behaviour. If you experience seeing, hearing or feeling things that are not there, this may also decrease or stop entirely.

It is important that you continue taking ziprasidone regularly even if you are feeling well, as it can prevent symptoms from returning. Talk with your doctor if you feel ziprasidone treatment has not been helpful or if the side effects are too bothersome. Your doctor may recommend switching you to a different medication.

This medication is not addictive. Do not stop taking it before talking to your doctor.

Possible common or serious side effects:

Side effects may be more common when starting a medication or after a dose increase. Talk to your doctor, nurse or pharmacist if any side effect concerns you.

• Dizziness, drowsiness or headache
• Feelings of agitation, anxiety or restlessness
• Stomach ache, nausea or constipation
• Increased appetite or weight gain
• Tiredness, drowsiness or difficulty sleeping
• Fast or irregular heartbeat
• Dry mouth or blurred vision
• Increased blood glucose or cholesterol levels

Contact your doctor immediately if you experience:

• Unexplained rash, seizure, fever or excessive sweating
• Fainting, feeling lightheaded or difficulty with balance
• Frequent urination accompanied by excessive thirst
• Breast tenderness or swelling (males and females)
• Shaking, muscle spasm/stiffness, pain or weakness
• Unusual movements of fingers, toes, neck, lips/tongue
• Thoughts of hurting yourself, suicide, increased hostility or worsening symptoms

How do I take this medication?

Ziprasidone is available as a capsule that is usually taken twice daily, at the same time(s) each day. Ziprasidone capsules should be taken with meals and swallowed whole with fluids. Do not open the capsules.

Usually, you will start with a low dose and slowly increase this dose over several days or weeks, based on how you tolerate it.

What precautions should my doctor and I be aware of when taking this medication?

• When you take this medication, your body may have difficulty maintaining a normal body temperature. Drink enough fluids to avoid becoming dehydrated. Avoid doing a lot of physical activity on hot days.
• While taking this medication, if you feel dizzy, drowsy or slowed down, do not drive a car or operate heavy machinery. Alcohol could make this worse. Try to avoid alcohol while taking ziprasidone.
• Ziprasidone can cause a rare side effect called “tardive dyskinesia.” Symptoms include involuntary movements of the lips, tongue, toes, hands or neck. Stopping or switching this medication at first signs will decrease the chances this side effect will continue. These movements may become permanent without a medication change.
• Ziprasidone can cause a rare side effect called “neuroleptic malignant syndrome.” Symptoms include severe muscle stiffness, high fever, sweating, increased or irregular heartbeat and increased blood pressure.

What special instructions should I follow while using this medication?

• Keep all appointments with your doctor and the lab. Your doctor may order lab tests to check how you are responding and to monitor for side effects.
• Try to keep a healthy, well-balanced diet and exercise regularly. Some people may gain weight as a result of increased appetite.
• Do not allow anyone else to use your medication.

What should I do if I forget to take a dose of this medication?

If you take ziprasidone regularly and forget to take a dose, take the missed dose as soon as you remember. However, if it is within 4 hours of your next scheduled dose, skip the missed dose and continue with your regular schedule. DO NOT double your next dose to try to ‘catch up’.

How do I store this medication?

Like other antipsychotics, ziprasidone affects actions of the brain chemicals dopamine and serotonin. The exact way that ziprasidone improves symptoms of schizophrenia, bipolar disorder and other conditions is not known.

How does this medication work?

Keep this medication in the original container, stored at room temperature away from moisture and heat and protected from light. Keep this medication out of reach and sight of children.

How well does the medication work in children and adolescents?

Ziprasidone has been shown to be better than placebo (an inactive pill) for treatment of manic episodes associated with bipolar disorder and Tourette syndrome in children and adolescents. Ziprasidone has been studied in children and adolescents with schizophrenia and has been shown to be no better than placebo. Ziprasidone is sometimes prescribed for the treatment of schizophrenia or bipolar disorder in patients who have experienced metabolic adverse effects or weight gain with other antipsychotics.

How long should I take the medication for?

This depends on the symptoms you have, how frequently they occur, and how long you have had them. Most people will need to take ziprasidone for several months. This allows time for symptoms to stabilize, and for function to improve. Your doctor will discuss the benefits and risks of taking ziprasidone with you. At this time, you can also discuss how long you might need to take this medication.

If you have schizophrenia and you tolerate ziprasidone well, you may be asked to take ziprasidone on an ongoing basis. Continuing treatment will significantly decrease the chance that your symptoms will return. Do not increase, decrease, or stop taking this medication without talking with your doctor. If you stop taking ziprasidone suddenly, it is possible that your symptoms may return or you may have a bad reaction.

TIP: Use the Kelty Mental Health Antipsychotic Monitoring Form for Children and Adolescents to help measure your progress on this medication. https://bit.ly/ap_monitoring

Also see the Kelty Mental Health document Atypical Antipsychotics & Metabolic Monitoring. https://bit.ly/ap_info