A second-generation (atypical) antipsychotic

Ziprasidone

A second-generation antipsychotic used for schizophrenia and bipolar disorder, taken with food and with attention to heart rhythm.

What is Ziprasidone?

Ziprasidone is a second-generation (atypical) antipsychotic used to treat schizophrenia and bipolar disorder. It helps settle symptoms such as hallucinations, disordered thinking and mood disturbance by acting on chemical messengers in the brain. Two practical points stand out: it must be taken with food, because food greatly improves how well it is absorbed, and it can affect the heart's electrical rhythm (the QT interval), so heart health and other medicines are reviewed. It can also cause sedation and some metabolic effects, so these are monitored.

Class: Second-generation (atypical) antipsychotic · Brands: Geodon, Zeldox

Education and reference only. This is a plain-language guide to Ziprasidone — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.

Written by Meds Global Health Clinical Team · Clinically reviewed by Dr Muhammad Suffyan, MB BS, Founder & Clinical Director · Last reviewed · How we review
Class: Second-generation (atypical) antipsychotic → Brands: Geodon, Zeldox
Ziprasidone (Second-generation (atypical) antipsychotic) — Meds Global Health reference card with 2D molecular structure
Ziprasidone — Second-generation (atypical) antipsychotic. The image shows the active ingredient's 2D molecular structure.

What it is

Ziprasidone is an antipsychotic medicine of the newer, second-generation (atypical) type. It is used to treat schizophrenia, a long-term mental-health condition, and bipolar disorder, where mood swings between highs and lows. It works on chemical messengers in the brain to reduce symptoms such as hallucinations, delusions, disordered thinking and disturbed mood. It is usually taken by mouth, with food, and is prescribed and monitored by mental-health specialists or under their guidance. As with other antipsychotics, it is part of a wider plan that may include other support and treatment.

How it works

Ziprasidone acts on several chemical messenger systems in the brain, particularly dopamine and serotonin. In conditions such as schizophrenia, the balance of these messengers is disturbed, and by adjusting their activity ziprasidone helps reduce symptoms like hallucinations and disordered thinking and helps steady mood in bipolar disorder. A key practical feature is that the body absorbs it far better when it is taken with food, so taking it with a proper meal is important for it to work reliably. Like other antipsychotics, it can also affect the heart's electrical rhythm, which is why heart health is considered.

Company & origin

Originated / developed by: Various manufacturers.

A second-generation antipsychotic used for schizophrenia and bipolar disorder; taken with food, with attention to the heart's rhythm.

What it treats

Conditions Ziprasidone is used for

Schizophrenia & psychosisA serious mental illness where a person loses some contact with reality — treated with ant…Bipolar disorderA long-term mood condition with episodes of mania or hypomania and depression — managed wi…

Practical use

How to take Ziprasidone

General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.

  • Always take it with food, as it is absorbed much better with a proper meal.
  • Take it regularly as prescribed, at about the same times each day.
  • Tell your prescriber about any heart problems, fainting or palpitations before and during treatment.
  • Be careful with driving or operating machinery until you know how drowsy it makes you.
  • Do not stop it suddenly; speak to your prescriber if you want to change or stop it.

Weighing it up

Advantages & disadvantages of Ziprasidone

Advantages

  • Effective for schizophrenia and bipolar disorder, reducing symptoms and steadying mood.
  • A second-generation antipsychotic option that may suit people who do not get on with others.
  • Tends to have less effect on weight than some other antipsychotics for many people.

Disadvantages

  • Must be taken with food, or it may not be absorbed and work properly.
  • Can affect the heart's rhythm (the QT interval), so heart health and other medicines are reviewed.
  • Can cause sedation and some metabolic effects, which need monitoring.

Practical use

Good to know

Two things are especially important with ziprasidone. First, always take it with food: it is absorbed much better with a meal, and taking it on an empty stomach can mean it does not work properly. Second, it can affect the heart's electrical rhythm (lengthening the QT interval), so your prescriber will ask about heart problems, fainting and family history, and will review other medicines that have the same effect; tell them about any palpitations, fainting or dizziness. Sedation and drowsiness are common, particularly at first, so take care with driving until you know how it affects you. As with other second-generation antipsychotics, it can have metabolic effects, such as changes in weight, blood sugar or cholesterol, so these are checked over time. Do not stop it suddenly without advice.

Who should not take it / use with caution

  • People who have had a serious allergic reaction to ziprasidone should not take it.
  • It is generally avoided in people with certain heart-rhythm problems, a long QT interval, or recent heart attack or heart failure.
  • It is used with caution alongside other medicines that affect the heart's QT interval, and in pregnancy on specialist advice.

Monitoring

  • Reviewing heart health, with heart tracing (ECG) checks where appropriate.
  • Monitoring weight, blood sugar and cholesterol over time.
  • Reviewing symptoms, side effects and overall response to treatment.

Side effects

  • Drowsiness or sedation, especially when starting.
  • Dizziness, restlessness or movement-related effects.
  • Changes in the heart's rhythm (the QT interval), and sometimes metabolic changes such as in weight or blood sugar.
  • Rarely but seriously, fainting, an abnormal heartbeat or a severe reaction, which need urgent attention.

Key interactions

  • Other medicines that affect the heart's QT interval should be reviewed, as effects can add up.
  • Alcohol and other sedating medicines can increase drowsiness.
  • Tell your prescriber about all your medicines, including over-the-counter and herbal ones.

Available as: Capsules taken by mouth with food, and a form for injection in some settings.

Answers

Ziprasidone: frequently asked questions

What is ziprasidone used for?

It is a second-generation antipsychotic used to treat schizophrenia and bipolar disorder, helping reduce symptoms and steady mood.

Why must I take it with food?

Ziprasidone is absorbed much better when taken with a proper meal, so taking it on an empty stomach can mean it does not work properly.

Does it affect the heart?

It can affect the heart's electrical rhythm (the QT interval), so your prescriber checks heart health and reviews other medicines that do the same.

Will it make me drowsy?

Sedation and drowsiness are common, especially at first, so take care with driving or machinery until you know how it affects you.

Can I stop it if I feel better?

Do not stop it suddenly; speak to your prescriber first, as stopping antipsychotics abruptly can cause problems and symptoms may return.

The wider class

About Second-generation (atypical) antipsychotic

Ziprasidone belongs to the second-generation (atypical) antipsychotic class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.

AntipsychoticsDrugs for psychosis, bipolar disorder and other conditions — balanced against movement and metabolic side-effects. QuetiapineAn atypical antipsychotic used in schizophrenia and bipolar disorder; can cause sedation, …OlanzapineAn effective atypical antipsychotic for schizophrenia and bipolar disorder, well known for…AripiprazoleAn atypical antipsychotic for schizophrenia and bipolar disorder that tends to be more wei…RisperidoneA widely used atypical antipsychotic for schizophrenia and bipolar disorder, available as …HaloperidolA long-established first-generation antipsychotic used for schizophrenia, agitation and ot…LurasidoneA second-generation antipsychotic used for schizophrenia, often chosen for its relatively …PaliperidoneA second-generation antipsychotic for schizophrenia, available as daily tablets or as a lo…SulpirideAn antipsychotic used to treat schizophrenia; it can raise prolactin and cause movement ef…AmisulprideA second-generation antipsychotic used for schizophrenia that can calm symptoms at higher …ChlorpromazineAn older 'first-generation' antipsychotic used to treat schizophrenia and other conditions…FlupentixolAn antipsychotic for schizophrenia that can be taken as tablets or given as a long-acting …TrifluoperazineA first-generation antipsychotic used in schizophrenia and other psychosis, and at lower a…LevomepromazineA sedating antipsychotic used in psychosis but, in UK practice, most often in palliative c…PericyazineA first-generation (older) antipsychotic used for schizophrenia and severe agitation.…ZuclopenthixolAn older antipsychotic for schizophrenia, available as tablets and as a long-acting depot …AsenapineA second-generation antipsychotic taken as a tablet that dissolves under the tongue, used …CariprazineA second-generation antipsychotic for schizophrenia with a long-lasting effect in the body…DroperidolA butyrophenone medicine used mainly to prevent and treat nausea and vomiting, especially …BenperidolAn antipsychotic occasionally used under specialist care to control deviant antisocial sex…LoxapineAn antipsychotic medicine; its inhaled form is used in hospital settings to calm sudden ag…PericiazineAn older phenothiazine antipsychotic, also used for severe anxiety or agitation, that is m…PimozideAn antipsychotic tablet used for schizophrenia and a specific delusional condition, which …PipotiazineA long-acting antipsychotic given by injection to maintain treatment for schizophrenia.…PromazineAn older antipsychotic used mainly for short-term agitation and restlessness, especially i…FluphenazineAn older antipsychotic used for schizophrenia, often as a long-acting depot injection that…PerphenazineA first-generation antipsychotic used for conditions such as schizophrenia, and also to tr…BrexpiprazoleA newer antipsychotic used for schizophrenia and as an add-on in depression that has not r…IloperidoneA second-generation antipsychotic used to treat schizophrenia, with the dose built up slow…ThiothixeneA first-generation antipsychotic used to treat schizophrenia, more commonly seen as a Unit…Aripiprazole lauroxilA long-acting depot injection of the antipsychotic aripiprazole, given every few weeks to …LumateperoneA newer once-daily antipsychotic used for schizophrenia and for bipolar depression.…MolindoneAn older first-generation antipsychotic used to treat schizophrenia, mainly available in t…PimavanserinA medicine used to treat the hallucinations and delusions (psychosis) that can occur in Pa…ClozapineThe most effective medicine for schizophrenia that has not responded to other treatments —…

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Mental healthConditions and medicines for mood, anxiety, psychosis, sleep and dependence — used alongsi…

Authoritative sources

  • BNF
  • NICE CKS

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