Ziprasidone
Using Ziprasidone
in Children and Adolescents
Overview
Ziprasidone (Canada - Zeldox®, USA – Geodon®) belongs to a group of medications called “atypical
antipsychotics” or “second-generation antipsychotics”.
What is ziprasidone used for?
Like many medications used to treat childhood disorders, ziprasidone has not been approved by Health Canada for
use in children and adolescents. When the potential benefits (e.g., reducing your symptoms) of using ziprasidone
outweigh the potential risks (e.g., the side effects), many doctors may prescribe it “off-label” to treat several conditions
such as:
• Schizophrenia and other thought disorders
• Symptoms associated with autism
• Bipolar disorder
• Tourette syndrome
Your doctor may be using this medication for another reason. If you are unclear why this medication is being
prescribed, please ask your doctor.
How does ziprasidone work?
Like other atypical antipsychotics, ziprasidone affects the levels of certain chemicals in the brain
called dopamine and serotonin. This has been shown to help people who have disorders like
schizophrenia and bipolar disorder with their symptoms. The exact way that antipsychotics improve
the symptoms of schizophrenia and bipolar disorder is not fully known.
How well does ziprasidone work in children and adolescents?
Current evidence supports the use of ziprasidone in children and adolescents. Ziprasidone has been shown in a study
to be better than placebo (an inactive pill that looks like the medication) for treating bipolar disorder and Tourette
syndrome in children and adolescents. Although the majority of information for the use of ziprasidone in schizophrenia
is from trials done in adults, more trials in children and adolescents are currently underway.
How should ziprasidone be taken?
Ziprasidone is available as a capsule that is usually taken twice daily. It should be taken with food to improve
absorption. This medication should be taken at the same times each day as directed by your doctor. Try to connect
taking it with something you do each day (like eating breakfast, or brushing your teeth) so that you don’t forget. Try to
avoid alcohol while taking ziprasidone.
Usually, your doctor will start with a low dose of ziprasidone that is best suited to your age and weight. The dose will
then be slowly increased over a few weeks based on how you respond. You and your doctor can then discuss the
best dosage to stay on based on how you tolerate this medication (how well it helps decrease your symptoms and
how you are doing with side effects).
Ziprasidone
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Child & Adolescent Mental Health Programs,
BC Children’s Hospital, 4480 Oak Street, Vancouver, B.C., Canada V6H 3V4
When will ziprasidone start working?
This depends on what you are using it for. Some improvements may be seen in as little as 1 to 2 weeks. However, it
can sometimes take up to 6 weeks to see the full benefits of the medication. When ziprasidone is working well, you
may notice that your thoughts are clearer and more organized. Agitation may be decreased and hearing voices or
seeing things no one else sees (hallucinations) may stop completely or happen much less. Your mood may be more
settled and you may see a reduction of intense fears and worries. It is important that you continue taking ziprasidone
regularly even if you are feeling well, as it can prevent symptoms from returning. If you are taking this medication to
help with symptoms of mood disturbance, you may notice some changes in the first 1 to 2 weeks.
Medications like ziprasidone do not work for everyone. If you are not feeling better within 6 weeks, your doctor may
recommend switching you to a different medication.
How long do I have to take ziprasidone?
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 your
symptoms to stabilize and for you to regain your functioning. 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.
Do not increase, decrease, or stop taking this medication without discussing it with your doctor. If you stop
taking ziprasidone suddenly, it is possible that your symptoms may return or you may have a bad reaction.
Is ziprasidone addictive?
No, ziprasidone is not addictive and you will not have “cravings” for this medication like you might with nicotine or
street drugs. If you and your doctor decide it is best for you to stop taking ziprasidone, your doctor will explain how to
safely come off this medication so you don’t feel negative effects as your body adjusts to being without it.
What are the side effects of ziprasidone and what should I do if I get them?
As with most medications, side effects may occur when taking ziprasidone. However, most side effects are mild and
temporary. Sometimes the side effects may occur before any of the beneficial effects. It is also possible for some
individuals to experience side effects that they feel are concerning or long-lasting. If this occurs, speak to your doctor
about ways to manage them. Below are some of the more common side effects of taking this medicine. In brackets
are suggested ways to lessen these effects.
Common side effects
Side effects are usually more common when starting a medication or after a dose increase. If any of these side effects
is troublesome for you, please discuss them with your doctor, nurse or pharmacist.
• Agitation, anxiety or restlessness (avoid caffeine from energy drinks, colas and coffee)
• Blurred vision (this effect often becomes less noticeable over time)
• Constipation (increase exercise, fluids, vegetables, fruits and fiber)
• Dizziness (try getting up slowly from a sitting or lying down position)
• Dry mouth (try chewing sugarless gum, sour candies, ice chips, or popsicles)
• Headache (try using a pain reliever like acetaminophen (plain Tylenol®))
• Increase in hunger (avoid high calorie foods)
• Nausea, upset stomach, poor appetite (try taking the medication with food)
• Stomach ache (try taking the medication with food)
• Tiredness, drowsiness, or difficulty falling asleep (speak with your doctor if these effects persist)
• Weight gain (monitor your food intake, increase your exercise)
Ziprasidone
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Child & Adolescent Mental Health Programs,
BC Children’s Hospital, 4480 Oak Street, Vancouver, B.C., Canada V6H 3V4
Uncommon side effects (e.g., those that occur in less than 5% of patients)
Contact your doctor IMMEDIATELY if you have any of these side effects:
• Fainting, feeling lightheaded or difficulties with balance
• Fast or irregular heart beat
• Feelings of restlessness
• Fever or excessive sweating
• Frequent urination accompanied by excessive thirst
• Rash
• Seizures
• Shaking, stiffness or difficulty moving, muscle spasm or stiffness in your throat or tongue
• Thoughts of hurting yourself, suicide, increased irritability/hostility or feeling worse
• Weakness or severe muscle pain
Ziprasidone is sometimes associated with a very rare side effect called “neuroleptic malignant syndrome”. The
symptoms may include severe muscle stiffness, high fever, increased heart rate and blood pressure, irregular
heartbeat (pulse) and sweating. Contact your doctor right away if this occurs.
On rare occasions, medications like ziprasidone have been associated with a side effect called “tardive dyskinesia”.
This is a side effect that can sometimes become permanent in patients who take antipsychotic medications. It involves
involuntary movements of some muscles in the body like the lips, tongue, toes, hands and neck. Stopping the
antipsychotic at the first signs of it occurring or switching to another “atypical” antipsychotic can decrease the chances
of having this side effect continue.
Tip: Ziprasidone can make some individuals feel drowsy, dizzy, or slowed down. If you experience
these temporary side effects, it is important to avoid operating heavy machinery or driving a car.
What precautions should my doctor and I be aware of when taking ziprasidone?
Tell your doctor or pharmacist if you:
• Have any allergies, or have experienced a reaction to a medication.
• Are lactose intolerant (ziprasidone capsules contain lactose).
• Are taking, or plan to start taking any other prescription or non-prescription medications (including herbal
products). Some medications may interact with ziprasidone and should not be taken with ziprasidone. Your
doctor may need to change the medications, the doses of your medications, or monitor you carefully for side
effects if you are taking medications that interact with ziprasidone.
• Have a history of low blood pressure, diabetes, kidney disease, blood or bone marrow problems, seizures, or
a personal or family history of a heart condition.
• Miss a period, are pregnant (or planning to become pregnant) or are breast-feeding.
• Are currently using alcohol or street drugs. These substances may interfere with how well ziprasidone works
for you and/or make you feel drowsy.
Tip: When taking this medication, your body may have difficulty regulating your temperature.
Make sure you drink lots of fluids or water to avoid becoming dehydrated. You should avoid doing a lot of
physical activities on hot days.
Ziprasidone
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Child & Adolescent Mental Health Programs,
BC Children’s Hospital, 4480 Oak Street, Vancouver, B.C., Canada V6H 3V4
What special instructions should I follow while using ziprasidone?
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check
how you are responding to ziprasidone, and to monitor for side effects.
Do not allow anyone else to use your medication.
Tip: Use the Antipsychotic Monitoring Form for Children and Adolescents to help measure your
progress on this medication. Also see the document Atypical Antipsychotics & Metabolic Monitoring.
What should I do if I forget to take a dose of ziprasidone?
If you take ziprasidone regularly and you forget to take it, take the missed dose as soon as you remember. However,
if it is almost time for your next dose (e.g. within 4 hours), skip the missed dose and continue with your regular dosing
schedule. Do NOT double your next dose.
What storage conditions are needed for ziprasidone?
• Keep this medication in the original container, stored at room temperature away from
moisture and heat (e.g. not in the bathroom or kitchen) and protected from light.
• Keep this medication out of reach and sight of children
You may wish to share this information with your family members to help them to understand your treatment options.
Since every person's needs are different, it is important that you follow the advice provided to you by your own doctor,
nurse and/or pharmacist and speak to them if you have any questions about this medication.
Developed by the health care professionals of
Child & Adolescent Mental Health Program and reviewed
by the staff of the Kelty Mental Health Resource Centre.
Ziprasidone
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Child & Adolescent Mental Health Programs,
BC Children’s Hospital, 4480 Oak Street, Vancouver, B.C., Canada V6H 3V4
