Ziprasidone: What it treats, how to take it, and what to watch for

Ziprasidone (brand name Geodon) is an antipsychotic used for schizophrenia and acute mania in bipolar disorder. It can calm psychosis and mood spikes without the heavy weight gain some other drugs cause, but it needs a few safety checks — most importantly, watching the heart rhythm.

It comes as an oral capsule and an injectable for short-term agitation. A key point: take the capsule with food. Eating about 500 calories with the pill boosts absorption a lot. Missing that can make the dose less effective.

Typical dosing and practical tips

For adults, doctors often start oral ziprasidone at 20 mg twice daily and increase slowly. Many patients end up around 40–80 mg twice daily; the usual maximum is 80 mg twice daily (160 mg/day). The injectable form is used in emergencies (agitation) — common IM doses are 10–20 mg with limits on total daily IM dosing. Always follow your prescriber's schedule.

Don't stop ziprasidone suddenly. If you need to stop, your doctor will usually taper the dose to avoid withdrawal or return of symptoms. If you feel overly sleepy, dizzy, or shaky after a dose change, tell your prescriber — dose adjustments or timing changes can help.

Side effects, warnings, and interactions

Common side effects include drowsiness, dizziness, restlessness (akathisia), nausea, and sometimes stiffness or tremor. Less common but important risks are QT prolongation (an electrical change on the ECG), low blood pressure when standing, and movement disorders like tardive dyskinesia if used long term.

Because ziprasidone can affect heart rhythm, doctors usually check a baseline ECG if you have heart disease, fainting, or take other drugs that lengthen the QT interval. Avoid ziprasidone if you have congenital long QT syndrome, recent heart attack, or severe heart failure unless a cardiologist agrees.

Drug interactions matter: combining ziprasidone with other QT-prolonging medicines raises risk. Strong CYP3A4 inhibitors (for example, some antifungals or HIV drugs) can increase ziprasidone levels; enzyme inducers (like carbamazepine) can lower its effect. Alcohol and sedatives increase drowsiness, so don’t mix them without advice.

Simple monitoring helps keep you safe: baseline and follow-up ECGs if needed, check electrolytes if you’re vomiting or on diuretics, and periodic weight, blood sugar, and lipids. Report warning signs right away — fainting, chest pain, very fast or irregular heartbeat, severe muscle stiffness, or high fever.

Questions to ask your prescriber: Why pick ziprasidone over other antipsychotics? How long should I try it before judging benefit? What should I do about missed doses? Keep a current list of your medicines and tell every provider about ziprasidone so they can avoid risky combos.

If you want help interpreting your ECG or understanding side effects, ask your pharmacist or doctor — a short conversation can prevent a big problem later.