Ziprasidone (patient information)

# IMPORTANT WARNING:
Studies have shown that older adults with dementia (a brain disorder that affects the ability to remember, think clearly, communicate, and perform daily activities and that may cause changes in mood and personality) who take antipsychotics (medications for mental illness) such as ziprasidone have an increased risk of death during treatment.Older adults with dementia may also have a greater chance of having a stroke or mini-stroke during treatment. If you experience any of the following symptoms, call your doctor immediately: slow or difficult speech, sudden dizziness or faintness, or weakness or numbness of an arm or leg.
Ziprasidone is not approved by the Food and Drug Administration (FDA) for the treatment of behavior problems in older adults with dementia. Talk to the doctor who prescribed this medication if you, a family member, or someone you care for has dementia and is taking ziprasidone. For more information visit the FDA website: 

# Why is this medication prescribed
Ziprasidone is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions). It is also used to treat episodes of mania (frenzied, abnormally excited or irritated mood) or mixed episodes (symptoms of mania and depression that happen together) in patients with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Ziprasidone is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.

# How should this medicine be used
Ziprasidone comes as a capsule to take by mouth. It is usually taken twice a day with food. Take ziprasidone at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ziprasidone exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Your doctor may start you on a low dose of ziprasidone and gradually increase your dose.
Ziprasidone may help control your symptoms but will not cure your condition. Continue to take ziprasidone even if you feel well. Do not stop taking ziprasidone without talking to your doctor.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# What special precautions should I follow
Before taking ziprasidone
- tell your doctor and pharmacist if you are allergic to ziprasidone or any other medications.
- tell your doctor if you are taking amiodarone (Cordarone, Pacerone), chlorpromazine (Thorazine), cisapride (Propulsid) (no longer available in the U.S.), disopyramide (Norpace), dofetilide (Tikosyn), dolasetron (Anzemet), droperidol (Inapsine), erythromycin (E.E.S., E-Mycin, Erythrocin), gatifloxacin (Tequin)(no longer available in the U.S.), halofantrine (Halfan)(no longer available in the U.S.), levomethadyl (ORLAAM) (no longer available in the U.S.), mefloquine (Lariam), mesoridazine (Serentil)(no longer available in the U.S..), moxifloxacin (Avelox), pentamidine (NebuPent, Pentam 300), pimozide (Orap), procainamide (Procanbid, Promine, Pronestyl), quinidine (Quinidex), sotalol (Betapace), sparfloxacin (Zagam), tacrolimus (Prograf), or thioridazine (Mellaril). Your doctor may tell you not to take ziprasidone if you are taking one or more of these medications.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antidepressants; certain antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), and voriconazole (Vfend); aprepitant (Emend); carbamazepine (Tegretol); clarithromycin (Biaxin, in Prevpac); cyclosporine (Neoral, Sandimmune); delavirdine (Rescriptor); diltiazem (Cardizem, Dilacor, Tiazac, others); diuretics ('water pills');dopamine agonists such as bromocriptine (Parlodel), cabergoline (Dostinex), levodopa (Dopar, Larodopa), pergolide (Permax), and ropinirole (Requip); efavirenz (Sustiva); fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); HIV protease inhibitors including atazanavir (Reyataz), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase, Invirase); hormonal contraceptives (birth control pills, rings, patches, implants, and injections); lovastatin (Mevacor, in Advicor); medications for anxiety, high blood pressure or seizures; nefazodone; sertraline (Zoloft); sleeping pills; tranquilizers; troleandomycin (TAO)(no longer available in the U.S..); verapamil (Calan, Covera, Isoptin, Verelan); and zafirlukast (Accolate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you use or have ever used street drugs or have overused prescription medications or if you have recently had a heart attack or have trouble swallowing. Also tell your doctor if you have or have ever had heart or liver disease, breast cancer, heart failure, an irregular heartbeat, a stroke or mini-stroke, or seizures, or if you or anyone in your family has or has ever had diabetes. Also tell your doctor if you have ever had to stop taking a medication for mental illness because of severe side effects.
- tell your doctor if you are pregnant or plan to become pregnant. If you become pregnant while taking ziprasidone, call your doctor. Do not breast-feed while taking ziprasidone.
- you should know that ziprasidone may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
- you should know that alcohol can add to the drowsiness caused by this medication. Do not drink alcohol while taking ziprasidone.
- you should know that you may experience hyperglycemia (increases in your blood sugar) while you are taking this medication, even if you do not already have diabetes. If you have schizophrenia , you are more likely to develop diabetes than people who do not have schizophrenia, and taking ziprasidone or similar medications may increase this risk. Tell your doctor immediately if you have any of the following symptoms while you are taking ziprasidone: extreme thirst, frequent urination, extreme hunger, blurred vision, or weakness. It is very important to call your doctor as soon as you have any of these symptoms, because high blood sugar that is not treated can cause a serious condition called ketoacidosis. Ketoacidosis may become life-threatening if it is not treated at an early stage. Symptoms of ketoacidosis include: dry mouth,nausea and vomiting, shortness of breath, breath that smells fruity, and decreased consciousness.
- you should know that ziprasidone may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking ziprasidone. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
- you should know that ziprasidone may make it harder for your body to cool down when it gets very hot. Tell your doctor if you plan to do vigorous exercise or be exposed to extreme heat.

# What special dietary instructions should I follow
Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medicine.
Be sure to drink plenty of water every day while you are taking this medication.

# What should I do if I forget a dose
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

# Side Effects

## Mild side effects
Ziprasidone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- drowsiness
- headache
- restlessness
- anxiety
- constipation
- diarrhea
- loss of appetite
- muscle pain
- runny nose, sneezing
- cough
- weight gain

## Severe side effects
Some side effects can be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNING section or the SPECIAL PRECAUTIONS section, call your doctor immediately:
- unusual movements of your face or body that you cannot control
- fast, irregular, or pounding heartbeat
- rash or hives
- fever
- muscle stiffness
- confusion
- sweating
- painful erection of the penis that lasts for hours
Ziprasidone may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# What storage conditions are needed for this medicine
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- drowsiness
- slurred speech
- sudden movements that you cannot control
- uncontrollable shaking of a part of the body
- anxiety

# What other information should I know
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to ziprasidone.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Geodon