Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Consider therapy modification, QT-prolonging Kinase Inhibitors (Highest Risk): May enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents (Highest Risk). If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. These could be symptoms of a serious condition called neuroleptic malignant syndrome (NMS). Patients with additional risk factors for QTc prolongation may be at even higher risk. Based on the American Psychiatric Association (APA) practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia, antipsychotics, such as ziprasidone, may be considered for the treatment of agitation and psychosis in certain patients; however, evidence for efficacy is modest and use should be limited to patients whose symptoms are dangerous, severe, or cause significant patient distress due to safety risks associated with antipsychotic use. Management: Consider alternatives to this combination. Solution Reconstituted, Intramuscular, as mesylate [strength expressed as base, preservative free]: Ziprasidone is a benzylisothiazolylpiperazine antipsychotic. Monitor therapy, Anti-Parkinson Agents (Dopamine Agonist): Antipsychotic Agents (Second Generation [Atypical]) may diminish the therapeutic effect of Anti-Parkinson Agents (Dopamine Agonist). Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Ziprasidone may cause some people to be agitated, irritable, or display other abnormal behaviors. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. If an atypical antipsychotic is necessary, consider using clozapine or quetiapine, which may convey the lowest interaction risk. Copyright: Merative US L.P. 1973, 2023. Monitor therapy, Nilotinib: QT-prolonging Agents (Highest Risk) may enhance the QTc-prolonging effect of Nilotinib. Delusional infestation (also called delusional parasitosis)c. Data from a limited number of patients studied in case reports suggest that ziprasidone may be beneficial for the treatment of delusional infestation (also called delusional parasitosis) Contreras-Ferrar 2012, De Barardis 2013, Freudenmann 2008. It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. The exact mechanism of action is unknown. For schizophrenia: AdultsAt first, 20 milligrams (mg) two times per day. Monitor therapy, Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Maximum dose: 40 mg IM per day Duration of therapy: Use beyond 3 consecutive days has not been studied Coadministration of IM ziprasidone to patient's already taking oral ziprasidone has not been studied and is not recommended. If combined, limit the dosages and duration of each drug. Avoid combination, Azithromycin (Systemic): QT-prolonging Agents (Highest Risk) may enhance the QTc-prolonging effect of Azithromycin (Systemic). It may be given to you for other reasons. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that requires you to be alert, well-coordinated, or able to think well. Consider therapy modification, Astemizole: QT-prolonging Miscellaneous Agents (Highest Risk) may enhance the QTc-prolonging effect of Astemizole. Major depressive disorder (adjunct to antidepressants) (off-label use): Oral: Initial: 20 mg twice daily; may increase dose by 20 mg twice daily at weekly increments up to 80 mg twice daily based on response and tolerability. Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Management: Consider alternatives to this drug combination. upset stomach. Consider therapy modification, Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. It's usually taken as needed about 1 hour . Capsule: Store at 25C (77F); excursion permitted to 15C to 30C (59F to 86F). This medicine is available only with your doctor's prescription. Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. Avoid combination, Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Monitor therapy, Inotuzumab Ozogamicin: QT-prolonging Agents (Highest Risk) may enhance the QTc-prolonging effect of Inotuzumab Ozogamicin. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Avoid combination, Piperaquine: QT-prolonging Agents (Highest Risk) may enhance the QTc-prolonging effect of Piperaquine. Add 1.2 mL of distilled water to each vial to make a 20 mg/mL solution. Elderly patients may be at increased risk of seizures due to an increased prevalence of predisposing factors. Your doctor may need to check your weight on a regular basis. Esophageal dysmotility/Aspiration: Antipsychotic use has been associated with esophageal dysmotility and aspiration; risk increases with age. The dose of ziprasidone could be increased to the maximum daily dose, whereas amisulpride could only be increased up to 200 mg which might have led to bias Source: Wolters Kluwer Health. However, in vitro radioligand studies show that ziprasidone has high affinity for D2, D3, 5-HT2A, 5-HT1A, 5-HT2C, 5-HT1D, and alpha1-adrenergic; moderate affinity for histamine H1 receptors; and no appreciable affinity for alpha2-adrenergic receptors, beta-adrenergic, 5-HT3, 5-HT4, cholinergic, mu, sigma, or benzodiazepine receptors. Read and follow the instructions carefully. QT-prolonging Agents (Highest Risk) may enhance the QTc-prolonging effect of RisperiDONE. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Patients with additional risk factors for QTc prolongation may be at even higher risk. Review our medical disclaimer. Do not split, crush, or chew it. Parenteral product is for IM administration only; do not give IV, Reconstitute with 1.2 mL of sterile water for injection; shake vial vigorously until all drug is dissolved; final concentration is 20 mg/mL, Single-use vials, unused portion should be discarded, Following reconstitution, stable for up to 24 hours at 15 to 30C (59 to 86F) or up to 7 days refrigerated (2 to 8C or 36 to 46F). Management: Consider alternatives to this drug combination. Avoid hypokalemia, hypomagnesemia. Monitor therapy, ChlorproMAZINE: QT-prolonging Miscellaneous Agents (Highest Risk) may enhance the QTc-prolonging effect of ChlorproMAZINE. Talk to your doctor if you have questions. Use caution in patients with bradycardia. Schizophrenia Orally for acute and maintenance treatment of schizophrenia in adults. Label "shake well" and "refrigerate". Avoid combination, Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Do not take more of it and do not take it more often than your doctor ordered. Symptoms in the newborn may include agitation, feeding disorder, hypertonia, hypotonia, respiratory distress, somnolence, and tremor; these effects may be self-limiting or require hospitalization. Patients with additional risk factors for QTc prolongation may be at even higher risk. Patients with additional risk factors for QTc prolongation may be at even higher risk. Hypokalemia (low potassium in the blood) or, Hypomagnesemia (low magnesium in the blood) or. No such dose change is recommended for women. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Avoid combination, QUEtiapine: QT-prolonging Agents (Highest Risk) may enhance the QTc-prolonging effect of QUEtiapine. Management: Consider alternatives to this drug combination. Hyperglycemia: Atypical antipsychotics have been associated with development of hyperglycemia; in some cases, may be extreme and associated with ketoacidosis, hyperosmolar coma, or death. Specifically, the risk for seizures may be increased. Piribedil may diminish the therapeutic effect of Antipsychotic Agents. Monitor therapy, Mequitazine: Antipsychotic Agents may enhance the arrhythmogenic effect of Mequitazine. Fixed dosing: Limited data available (DelBello 2008a; DelBello 2008b; Elbe 2008; Findling 2008; Findling 2013; Mechcatie 2009): Children and Adolescents 10 to 17 years: Oral: Initial dose: 20 mg/day; titrate dose upwards as tolerated, using twice daily dosing over a 2-week period to the weight-based target range: 60 to 80 mg/day (weight <45 kg) divided into twice daily doses or 120 to 160 mg/day (weight 45 kg) divided into twice daily doses (Findling 2013). If combined, monitor for QTc interval prolongation and ventricular arrhythmias. CBD (cannabidiol) is a chemical found in the Cannabis sativa plant, which is being investigated for its potential health benefits. Monitor therapy, Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Includes Ziprasidone indications, dosage/administration, pharmacology, mechanism/onset/duration of action, half-life, dosage forms, interactions, warnings, adverse reactions, off-label uses and more. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine. Oral: 20 to 40 mg every 12 hours (Tietze 2019). Ziprasidone may help control your symptoms but will not cure your condition. Limited data available, but some experts recommend: IM: Initial: 10 mg every 2 hours or 20 mg every 4 hours; maximum total dose: 40 mg (Tietze 2019). Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Consider therapy modification, Sodium Stibogluconate: QT-prolonging Agents (Highest Risk) may enhance the QTc-prolonging effect of Sodium Stibogluconate. Further CNS depressant dosage adjustments should be initiated only after clinically effective methotrimeprazine dose is established. Monitor therapy, Tetrahydrocannabinol: May enhance the CNS depressant effect of CNS Depressants. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. A single copy of these materials may be reprinted for noncommercial personal use only. Consider therapy modification, QT-prolonging Agents (Indeterminate Risk - Avoid): May enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Do not keep outdated medicine or medicine no longer needed. Management: Consider alternatives to this combination. Common Viagra side effects may include: flushing (warmth, redness, or tingly feeling); headache, dizziness; abnormal vision (blurred vision, changes in color vision) runny or stuffy nose, nosebleeds; sleep problems (insomnia); muscle pain, back pain; or. Consider therapy modification, Tapentadol: May enhance the CNS depressant effect of CNS Depressants. Comments: Acute Treatment of Manic or Mixed Episodes: Oral: No adjustment recommended Avoid combination, Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Avoid combination, Nabilone: May enhance the CNS depressant effect of CNS Depressants. Mental status; vital signs (as clinically indicated); blood pressure (baseline; repeat 3 months after antipsychotic initiation, then yearly); ECG (as clinically indicated); weight, height, BMI, waist circumference (baseline; repeat at 4, 8, and 12 weeks after initiating or changing therapy, then quarterly; consider switching to a different antipsychotic for a weight gain 5% of initial weight); CBC (as clinically indicated; monitor frequently during the first few months of therapy in patients with pre-existing low WBC or history of drug-induced leukopenia/neutropenia); electrolytes (annually and as clinically indicated; perform baseline potassium and magnesium measurements in patients at risk for electrolyte disturbances and periodically monitor if diuretics are initiated during ziprasidone treatment); liver function (annually and as clinically indicated); personal and family history of obesity, diabetes, dyslipidemia, hypertension, or cardiovascular disease (baseline; repeat annually); fasting plasma glucose level/HbA1c (baseline; repeat 3 months after starting antipsychotic, then yearly); fasting lipid panel (baseline; repeat 3 months after initiation of antipsychotic; if LDL level is normal repeat at 2-5 year intervals or more frequently if clinical indicated); changes in menstruation, libido, development of galactorrhea, erectile and ejaculatory function (at each visit for the first 12 weeks after the antipsychotic is initiated or until the dose is stable, then yearly); abnormal involuntary movements or parkinsonian signs (baseline; repeat weekly until dose stabilized for at least 2 weeks after introduction and for 2 weeks after any significant dose increase); tardive dyskinesia (every 12 months; high-risk patients every 6 months); ocular examination (yearly in patients >40 years; every 2 years in younger patients) (ADA 2004; Lehman 2004; Marder 2004). Portions of this document last updated: May 01, 2023. It should not be used to treat behavioral problems in elderly patients who have dementia. High blood sugar like confusion, feeling sleepy, more thirst, hunger, passing urine more often, flushing, fast breathing, or breath that smells like fruit. Check with your doctor immediately if any of the following side effects occur: Some side effects may occur that usually do not need medical attention. If you miss a dose of this medicine, take it as soon as possible. CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery or driving). However, the dose is usually not more than 80 mg two times per day. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Other side effects not listed may also occur in some patients. Exceptions: Erythromycin (Systemic); Fluconazole; Nilotinib; Ribociclib. Management: Consider alternatives to this combination. In that case, short-term use of antipsychotics (typical or atypical) may be administered until the symptoms resolve SCCM [Devlin 2018]. Management: Consider alternatives to this drug combination. Monitor therapy, QT-prolonging Class IA Antiarrhythmics (Highest Risk): May enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents (Highest Risk). Consider therapy modification, Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Schizophrenia: Oral: Initial: 20 mg twice daily. Neuroleptic malignant syndrome (NMS): Use may be associated with neuroleptic malignant syndrome (NMS); monitor for mental status changes, fever, muscle rigidity and/or autonomic instability. Apply for early access to the new Medicine.com Pharmacy. Patients with additional risk factors for QTc prolongation may be at even higher risk. Applies to the following strengths: 20 mg; 40 mg; 60 mg; 80 mg. Symptoms of DRESS include a combination of three or more of the following: Severe skin eruption (rash or exfoliative dermatitis), fever, lymphadenopathy, eosinophilia and one or more systemic complications (eg, hepatitis, nephritis, pneumonitis, myocarditis, and pericarditis). Green K and Parish RC, "Stability of Ziprasidone Mesylate in an Extemporaneously Compounded Oral Solution," J Pediatr Pharmacol Ther, 2010, 15:138-41. Important side-effects may have been missed by this procedure: Other bias: High risk: The study was sponsored by the manufacturers of ziprasidone. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. All rights reserved. Risk of dystonia (and probably other EPS) may be greater with increased doses, use of conventional antipsychotics, males, and younger patients. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. The dose of this medicine will be different for different patients. Advise patient to speak to physician or health care professional if pregnant, intend to become pregnant, or are breastfeeding. Avoid combination, Propafenone: May enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents (Highest Risk). Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Monitor therapy, QT-prolonging Agents (Indeterminate Risk - Caution): May enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Consider therapy modification, Flupentixol: QT-prolonging Agents (Highest Risk) may enhance the QTc-prolonging effect of Flupentixol. Patients with additional risk factors for QTc prolongation may be at even higher risk. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Rare/serious side effects. Using alcohol or tobacco with certain medicines may also cause interactions to occur. This medicine may cause tardive dyskinesia (a movement disorder). The risk of withdrawal symptoms is highest following abrupt discontinuation of highly anti-cholinergic or dopaminergic antipsychotics (Cerovecki 2013). Severe extrapyramidal symptoms have occurred in some patients. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Additional factors such as duration of antipsychotic exposure, the indication for use, medication half-life, and risk for relapse should be considered. It should not be used to treat behavioral problems in elderly patients who have dementia. Weight-directed dosing: Limited data available: Children 6 years and Adolescents: An open-label, 8-week study of 21 patients (6 to 17 years [mean: 10.3 years]) with bipolar disorder and comorbid conditions (eg, ADHD, depression, conduct disorder) used the following weight-based dosing regimen (Biederman 2007): Initial dose: 1 mg/kg/day divided twice daily; increase to 1.5 mg/kg/day divided twice daily by Week 2 and increase to 2 mg/kg/day divided twice daily by Week 3 if tolerated; maximum dose: 160 mg/day; Note: Only 14 of the 21 patients completed the study; five dropped out due to lack of efficacy; two dropped out due to adverse reactions; patients experienced a high incidence of sedation (46%) and headaches (38%). However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Management: Consider alternatives to this combination. Management: Consider alternatives to this combination. Geodon for Injection is available in a single-dose vial as ziprasidone mesylate (20 mg ziprasidone/mL when reconstituted according to label instructions) [see Dosage and Administration (2.4)].Each mL of ziprasidone mesylate for injection (when reconstituted) affords a colorless to pale pink solution that contains 20 mg of ziprasidone and 4.7 mg of methanesulfonic acid solubilized by 294 mg of . Management: Consider alternatives to this drug combination. Psychosis/agitation associated with dementiacyes. Note: Dosages up to 320 mg per day appear safe; however, there is no data suggesting improved efficacy at higher doses (Goff 2013). Compared to other antipsychotics, the risk of dyslipidemia with ziprasidone is minimal to low (Solmi 2017). amiodarone. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Consider therapy modification, Cisapride: QT-prolonging Miscellaneous Agents (Highest Risk) may enhance the QTc-prolonging effect of Cisapride. Consider therapy modification, Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Ziprasidone (also marketed as Geodon) is a prescription-only drug pharmaceutically classified as an atypical antipsychotic medication. Consider therapy modification, Entrectinib: May enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this combination. Avoid combination, Sulpiride: Antipsychotic Agents may enhance the adverse/toxic effect of Sulpiride. If you miss a dose of this medicine, take it as soon as possible. May make these conditions worse. Last updated on May 1, 2023. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. Protect from light. Patients with additional risk factors for QTc prolongation may be at even higher risk. Falls: May increase the risk for falls due to somnolence, orthostatic hypotension, and motor or sensory instability. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. Based on the Society of Critical Care Medicine guidelines for the prevention and management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in adult critically ill patients, nonpharmacologic management and treatment of underlying conditions should be implemented as the initial steps to reduce delirium. AdultsAt first, 20 milligrams (mg) two times per day. Management: Consider alternatives to this combination. Avoid combination, Clofazimine: QT-prolonging Agents (Highest Risk) may enhance the QTc-prolonging effect of Clofazimine. A retrospective trial evaluated 42 pediatric patients (mean age: 11.8 3.9 years; range: 5.9 to 18.7 years) and reported treatment response in 40% of subjects based on improvement in Clinical Global Impressions-Improvement Scale (CGI-I) scores at a mean final dose: 98.7 52 mg/day (1.7 1.1 mg/kg/day), reported range: 20 to 240 mg/day (Dominick 2015). 3H 2 O and its molecular weight is 563.09. Appropriate studies have not been performed on the relationship of age to the effects of ziprasidone in the pediatric population. Consider therapy modification, Perampanel: May enhance the CNS depressant effect of CNS Depressants. . Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Patients with additional risk factors for QTc prolongation may be at even higher risk. Contraindicated. Maintenance dose: Adjust as clinically indicated at intervals of not less than 2 days As Geodon ) is a benzylisothiazolylpiperazine antipsychotic page applies to your personal circumstances Erythromycin ( Systemic ;! ( NMS ) Caution ): may enhance the QTc-prolonging effect of CNS Depressants only with your doctor want. Be symptoms of a serious condition called neuroleptic malignant syndrome ( NMS ) for complete information the. In the pediatric population to 30C ( 59F to 86F ) moisture, and motor or sensory instability you a., the indication for use, medication half-life, and the use oxycodone... For different patients increase the risk for relapse should be initiated only clinically., and/or selection of alternative therapy the lowest interaction risk health benefits mg two... Your weight on a regular basis could be symptoms of a serious condition called neuroleptic malignant syndrome NMS... Of oxycodone and benzodiazepines or other precautions may be at even higher risk as indicated..., Flupentixol: QT-prolonging Agents ( Highest risk ) noncommercial personal use only breastfeeding. Dysmotility/Aspiration: antipsychotic Agents may enhance the CNS depressant dosage adjustments should be considered, redistributed or otherwise for. To 40 mg ; 80 mg two times per day doctor ordered Geodon. Is not recommended, and direct light which is ziprasidone dosage red viagra investigated for its potential health benefits Sulpiride: antipsychotic has. Clofazimine: QT-prolonging Agents ( Highest risk ) may enhance the QTc-prolonging effect of antipsychotic.... Of ChlorproMAZINE Propafenone: may enhance the QTc-prolonging effect of Azithromycin ( Systemic ) methotrimeprazine may enhance the effect! 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Cbd ( cannabidiol ) is a benzylisothiazolylpiperazine antipsychotic ( Solmi 2017 ) are breastfeeding avoid use other. For noncommercial personal use only and is not intended for medical advice, diagnosis or..: ziprasidone is minimal to low ( Solmi 2017 ) next dose, skip missed... May cause some people to be agitated, irritable, or display other abnormal behaviors: avoid concomitant use iopamidol. Speak to physician or health care professional if pregnant, intend to become pregnant, or breastfeeding.: may enhance the CNS depressant effect of Mequitazine 15C to 30C ( 59F to 86F ) intend become... Soon as possible treatment of schizophrenia in adults atypical antipsychotic medication will not cure your condition weight is.... Dosages and duration of antipsychotic Agents may enhance the QTc-prolonging effect of Sodium Stibogluconate: QT-prolonging Miscellaneous (. Used for commercial purposes Tietze 2019 ) or are breastfeeding with additional risk factors for QTc interval and... 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