Ziprasidone

Ziprasidone is approved by the US Food and Drug Administration (FDA) for the treatment of schizophrenia as well as acute mania and mixed states associated with bipolar disorder. Its intramuscular injection form is approved for acute agitation in schizophrenic patients for whom treatment with just ziprasidone is appropriate.{{cite web | url = http://www.stopmedicarefraud.gov/pfizerfactsheet.html | title = Pfizer to pay $2.3 billion to resolve criminal and civil health care liability relating to fraudulent marketing and the payment of kickbacks | publisher = Stop Medicare Fraud, US Dept of Health & Human Svc, and of US Dept of Justice | access-date = July 4, 2012 | archive-date = August 30, 2012 | archive-url = https://web.archive.org/web/20120830023954/http://www.stopmedicarefraud.gov/pfizerfactsheet.html | url-status = dead }}

In a 2013 study in a comparison of 15 antipsychotic drugs in effectiveness in treating schizophrenic symptoms, ziprasidone demonstrated mild-standard effectiveness. Ziprasidone was 15% more effective than lurasidone and iloperidone, approximately as effective as chlorpromazine and asenapine, and 9–13% less effective than haloperidol, quetiapine, and aripiprazole.{{cite journal | vauthors = Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, Samara M, Barbui C, Engel RR, Geddes JR, Kissling W, Stapf MP, Lässig B, Salanti G, Davis JM | display-authors = 6 | title = Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis | journal = Lancet | volume = 382 | issue = 9896 | pages = 951–962 | date = September 2013 | pmid = 23810019 | doi = 10.1016/S0140-6736(13)60733-3 | s2cid = 32085212 }} Ziprasidone is effective in the treatment of schizophrenia, though evidence from the CATIE trials suggests it is less effective than olanzapine, and equally as effective compared to quetiapine. There are higher discontinuation rates for lower doses of ziprasidone, which are also less effective than higher doses.{{cite journal | vauthors = Citrome L, Yang R, Glue P, Karayal ON | title = Effect of ziprasidone dose on all-cause discontinuation rates in acute schizophrenia and schizoaffective disorder: a post-hoc analysis of 4 fixed-dose randomized clinical trials | journal = Schizophrenia Research | volume = 111 | issue = 1–3 | pages = 39–45 | date = June 2009 | pmid = 19375893 | doi = 10.1016/j.schres.2009.03.009 | s2cid = 34910599 }}

Ziprasidone (and all other second generation antipsychotics (SGAs)) received a boxed warning in the US due to increased mortality in elderly people with dementia-related psychosis.

Sleepiness and headache are very common adverse effects (>10%).{{cite web|title=Product Information: Zeldox IM (ziprasidone mesilate)|url=https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-06852-3|publisher=Australia Therapeutic Goods Administration|date=February 24, 2016}}{{dead link|date=March 2025}}{{cite web|title=Product Information: Zeldox (ziprasidone hydrochloride)|url=https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-05917-3&d=2016100716114622483|publisher=Australia Therapeutic Goods Administration|date=February 24, 2016}}

Common adverse effects (1–10%), include producing too much saliva or having dry mouth, runny nose, respiratory disorders or coughing, nausea and vomiting, stomach aches, constipation or diarrhea, loss of appetite, weight gain (but the smallest risk for weight gain compared to other antipsychotics{{cite web|last1=FDA Psychopharmacological Drugs Advisory Committee|title=Briefing Document for Zeldoz Capsules|url=https://www.fda.gov/ohrms/dockets/ac/00/backgrd/3619b1a.pdf|archive-url=https://web.archive.org/web/20030308070927/http://www.fda.gov/ohrms/dockets/ac/00/backgrd/3619b1a.pdf|url-status=dead|archive-date=March 8, 2003|publisher=FDA|date=July 19, 2000}}), rashes, fast heart beats, blood pressure falling when standing up quickly, muscle pain, weakness, twitches, dizziness, and anxiety. Extrapyramidal symptoms are also common and include tremor, dystonia (sustained or repetitive muscle contractions), akathisia (the feeling of a need to be in motion), parkinsonism, and muscle rigidity; in a 2013 meta-analysis of 15 antipsychotic drugs, ziprasidone ranked 8th for such side effects.{{cite journal | vauthors = Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, Samara M, Barbui C, Engel RR, Geddes JR, Kissling W, Stapf MP, Lässig B, Salanti G, Davis JM | display-authors = 6 | title = Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis | journal = Lancet | volume = 382 | issue = 9896 | pages = 951–962 | date = September 2013 | pmid = 23810019 | doi = 10.1016/s0140-6736(13)60733-3 | s2cid = 32085212 }}

Ziprasidone is known to trigger mania in some bipolar patients.{{cite journal | vauthors = Baldassano CF, Ballas C, Datto SM, Kim D, Littman L, O'Reardon J, Rynn MA | title = Ziprasidone-associated mania: a case series and review of the mechanism | journal = Bipolar Disorders | volume = 5 | issue = 1 | pages = 72–75 | date = February 2003 | pmid = 12656943 | doi = 10.1034/j.1399-5618.2003.02258.x }}{{cite journal | vauthors = Keating AM, Aoun SL, Dean CE | title = Ziprasidone-associated mania: a review and report of 2 additional cases | journal = Clinical Neuropharmacology | volume = 28 | issue = 2 | pages = 83–86 | year = 2005 | pmid = 15795551 | doi = 10.1097/01.wnf.0000159952.64640.28 }}{{cite journal | vauthors = Davis R, Risch SC | title = Ziprasidone induction of hypomania in depression? | journal = The American Journal of Psychiatry | volume = 159 | issue = 4 | pages = 673–674 | date = April 2002 | pmid = 11925314 | doi = 10.1176/appi.ajp.159.4.673 }}

This medication can cause birth defects, according to animal studies, although this side effect has not been confirmed in humans.

Recently, the FDA required the manufacturers of some atypical antipsychotics to include a warning about the risk of hyperglycemia and Type II diabetes with atypical antipsychotics. Some evidence suggests that ziprasidone does not cause insulin resistance to the degree of other atypical antipsychotics, such as olanzapine. Weight gain is also less of a concern with ziprasidone compared to other atypical antipsychotics.{{cite journal | vauthors = Tschoner A, Engl J, Rettenbacher M, Edlinger M, Kaser S, Tatarczyk T, Effenberger M, Patsch JR, Fleischhacker WW, Ebenbichler CF | display-authors = 6 | title = Effects of six second generation antipsychotics on body weight and metabolism - risk assessment and results from a prospective study | journal = Pharmacopsychiatry | volume = 42 | issue = 1 | pages = 29–34 | date = January 2009 | pmid = 19153944 | doi = 10.1055/s-0028-1100425 | s2cid = 43803033 }}{{cite journal | vauthors = Guo JJ, Keck PE, Corey-Lisle PK, Li H, Jiang D, Jang R, L'Italien GJ | title = Risk of diabetes mellitus associated with atypical antipsychotic use among Medicaid patients with bipolar disorder: a nested case-control study | journal = Pharmacotherapy | volume = 27 | issue = 1 | pages = 27–35 | date = January 2007 | pmid = 17192159 | doi = 10.1592/phco.27.1.27 | s2cid = 22445126 | citeseerx = 10.1.1.453.7866 }}{{cite journal | vauthors = Sacher J, Mossaheb N, Spindelegger C, Klein N, Geiss-Granadia T, Sauermann R, Lackner E, Joukhadar C, Müller M, Kasper S | display-authors = 6 | title = Effects of olanzapine and ziprasidone on glucose tolerance in healthy volunteers | journal = Neuropsychopharmacology | volume = 33 | issue = 7 | pages = 1633–1641 | date = June 2008 | pmid = 17712347 | doi = 10.1038/sj.npp.1301541 | doi-access = free }}{{cite journal | vauthors = Newcomer JW | title = Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review | journal = CNS Drugs | volume = 19 | issue = Suppl 1 | pages = 1–93 | year = 2005 | pmid = 15998156 | doi = 10.2165/00023210-200519001-00001 | s2cid = 36435377 }} In fact, in a trial of long term therapy with ziprasidone, overweight patients (BMI > 27) actually had a mean weight loss overall. According to the manufacturer insert, ziprasidone caused an average weight gain of 2.2 kg (4.8 lbs), which is significantly lower than other atypical antipsychotics, making this medication better for patients that are concerned about their weight.

In December 2014, the FDA warned that ziprasidone could cause a potentially fatal skin reaction, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), although this was believed to occur only rarely.{{cite web | url=https://www.fda.gov/Drugs/DrugSafety/ucm426391.htm | title=FDA Drug Safety Communication: FDA reporting mental health drug ziprasidone (Geodon) associated with rare but potentially fatal skin reactions | website=FDA | date=December 11, 2014 | access-date=December 12, 2014}}{{dead link|date=May 2025|bot=medic}}{{cbignore|bot=medic}}

The British National Formulary recommends a gradual withdrawal when discontinuing antipsychotics to avoid acute withdrawal syndrome or rapid relapse.{{cite book |editor1-first=BMJ | editor = Joint Formulary Committee | title = British National Formulary | edition = 57 | date = March 2009 |publisher=Royal Pharmaceutical Society of Great Britain |location=United Kingdom |isbn=978-0-85369-845-6 |page=192 |chapter=4.2.1 |quote=Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse.}} Symptoms of withdrawal commonly include nausea, vomiting, and loss of appetite.{{cite book | vauthors = Haddad P, Dursun S, Deakin B |title=Adverse Syndromes and Psychiatric Drugs: A Clinical Guide |date=2004 |publisher=OUP Oxford |isbn=9780198527480 |pages=207–216 |url=https://books.google.com/books?id=CWR7DwAAQBAJ&pg=PA207 |language=en}} Other symptoms may include restlessness, increased sweating, and trouble sleeping. Less commonly there may be a feeling of the world spinning, numbness, or muscle pains. Symptoms generally resolve after a short period of time.

There is tentative evidence that discontinuation of antipsychotics can result in psychosis.{{cite journal | vauthors = Moncrieff J | title = Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse | journal = Acta Psychiatrica Scandinavica | volume = 114 | issue = 1 | pages = 3–13 | date = July 2006 | pmid = 16774655 | doi = 10.1111/j.1600-0447.2006.00787.x | s2cid = 6267180 }} It may also result in reoccurrence of the condition that is being treated.{{cite book | vauthors = Sacchetti E, Vita A, Siracusano A, Fleischhacker W |title=Adherence to Antipsychotics in Schizophrenia |date=2013 |publisher=Springer Science & Business Media |isbn=9788847026797 |page=85 |url=https://books.google.com/books?id=odE-AgAAQBAJ&pg=PA85 |language=en}} Rarely tardive dyskinesia can occur when the medication is stopped.

{{See also|Atypical antipsychotic#Pharmacodynamics|Antipsychotic#Comparison of medications}}

Ziprasidone mostly affects the receptors of dopamine (D₂), serotonin (5-HT_2A, partially 5-HT_1A, 5-HT_2C, and 5-HT_1D){{cite journal | vauthors = Seeger TF, Seymour PA, Schmidt AW, Zorn SH, Schulz DW, Lebel LA, McLean S, Guanowsky V, Howard HR, Lowe JA | display-authors = 6 | title = Ziprasidone (CP-88,059): a new antipsychotic with combined dopamine and serotonin receptor antagonist activity | journal = The Journal of Pharmacology and Experimental Therapeutics | volume = 275 | issue = 1 | pages = 101–113 | date = October 1995 | doi = 10.1016/S0022-3565(25)12023-5 | pmid = 7562537 | url = http://jpet.aspetjournals.org/cgi/pmidlookup?view=long&pmid=7562537 }}{{cite book| vauthors = Brunton L |title=Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th Edition|year=2011|publisher=McGraw-Hill|location=China|isbn=978-0-07-162442-8|pages=406–410}} and epinephrine/norepinephrine (α₁) to a high degree, while of histamine (H₁) - moderately.{{cite book | vauthors = Akiskal HS, Tohen M | title = Bipolar Psychopharmacotherapy: Caring for the Patient | url = https://books.google.com/books?id=u0fO8RRIE1MC&pg=PT209 | access-date = May 13, 2012 | date = June 24, 2011 | publisher = John Wiley & Sons | isbn = 978-1-119-95664-8 | page = 209}}{{cite journal | vauthors = Nemeroff CB, Lieberman JA, Weiden PJ, Harvey PD, Newcomer JW, Schatzberg AF, Kilts CD, Daniel DG | display-authors = 6 | title = From clinical research to clinical practice: a 4-year review of ziprasidone | journal = CNS Spectrums | volume = 10 | issue = 11 Suppl 17 | pages = 1–20 | date = November 2005 | pmid = 16381088 | doi = 10.1017/S1092852900019842 | s2cid = 26738197 }} It also somewhat inhibits reuptake of serotonin and norepinephrine, though not dopamine.{{cite journal | vauthors = Tatsumi M, Jansen K, Blakely RD, Richelson E | title = Pharmacological profile of neuroleptics at human monoamine transporters | journal = European Journal of Pharmacology | volume = 368 | issue = 2–3 | pages = 277–283 | date = March 1999 | pmid = 10193665 | doi = 10.1016/S0014-2999(99)00005-9 }}

Ziprasidone's efficacy in treating the positive symptoms of schizophrenia is believed to be mediated primarily via antagonism of the dopamine receptors, specifically D₂. Blockade of the 5-HT_2A receptor may also play a role in its effectiveness against positive symptoms, though the significance of this property in antipsychotic drugs is still debated among researchers.{{cite book | vauthors = Lüllmann H, Mohr K | title = Pharmakologie und Toxikologie: Arzneimittelwirkungen verstehen- Medikamente gezielt einsetzen; ein Lehrbuch für Studierende der Medizin, der Pharmazie und der Biowissenschaften, eine Informationsquelle für Ärzte, Apotheker und Gesundheitspolitiker | url = https://books.google.com/books?id=7ewS8QAClYEC&pg=PP1 | access-date = May 13, 2012 | year = 2006 | publisher = Georg Thieme Verlag | isbn = 978-3-13-368516-0 }} Blockade of 5-HT_2A and 5-HT_2C and activation of 5-HT_1A as well as inhibition of the reuptake of serotonin and norepinephrine may all contribute to its ability to alleviate negative symptoms.;{{cite book | vauthors = Schatzberg AF, Nemeroff CB | title = Essentials of Clinical Psychopharmacology | url = https://books.google.com/books?id=i5zrVD1PAwEC&pg=PA297 | access-date = May 13, 2012 | date = February 10, 2006 | publisher = American Psychiatric Pub | isbn = 978-1-58562-243-6 | page = 297}} however, its effects on the 5-HT_1A receptor may be limited as a study{{cite journal | vauthors = Bantick RA, Rabiner EA, Hirani E, de Vries MH, Hume SP, Grasby PM | title = Occupancy of agonist drugs at the 5-HT1A receptor | journal = Neuropsychopharmacology | volume = 29 | issue = 5 | pages = 847–859 | date = May 2004 | pmid = 14985704 | doi = 10.1038/sj.npp.1300390 | s2cid = 11509050 | doi-access = free }} found ziprasidone would likely "produce detectable occupancy [of 5-HT_1A receptors] only at higher doses that would produce unacceptable levels of side effects in man, although lower doses are sufficient to produce pharmacological effects." The relatively weak antagonistic actions of ziprasidone on the α₁-adrenergic receptor likely in part explains some of its side effects, such as orthostatic hypotension. Unlike many other antipsychotics, ziprasidone has no significant affinity for the mACh receptors, and as such lacks any anticholinergic side effects. Like most other antipsychotics, ziprasidone is sedating due primarily to serotonin and dopamine blockade.{{cite journal | vauthors = Monti JM | title = Serotonin 5-HT(2A) receptor antagonists in the treatment of insomnia: present status and future prospects | journal = Drugs of Today | volume = 46 | issue = 3 | pages = 183–193 | date = March 2010 | pmid = 20467592 | doi = 10.1358/dot.2010.46.3.1437247 }}{{cite journal | vauthors = Salmi P, Ahlenius S | title = Sedative effects of the dopamine D1 receptor agonist A 68930 on rat open-field behavior | journal = NeuroReport | volume = 11 | issue = 6 | pages = 1269–1272 | date = April 2000 | pmid = 10817605 | doi = 10.1097/00001756-200004270-00025 | s2cid = 35263421 }}

The systemic bioavailability of ziprasidone is 100% when administered intramuscularly and 60% when administered orally without food.

After a single dose intramuscular administration, the peak serum concentration typically occurs at about 60 minutes after the dose is administered, or earlier.{{cite web|url=https://www.drugs.com/ppa/ziprasidone.html|title=Ziprasidone (Professional Patient Advice)|website=Drugs.com|access-date=February 2, 2016}} Steady state plasma concentrations are achieved within one to three days. Exposure increases in a dose-related manner and following three days of intramuscular dosing, little accumulation is observed.

The bioavailability of the drug is reduced by approximately 50% if a meal is not eaten before Ziprasidone ingestion.{{cite journal | vauthors = Miceli JJ, Glue P, Alderman J, Wilner K | title = The effect of food on the absorption of oral ziprasidone | journal = Psychopharmacology Bulletin | volume = 40 | issue = 3 | pages = 58–68 | year = 2007 | pmid = 18007569 }}

Ziprasidone is hepatically metabolized by aldehyde oxidase; minor metabolism occurs via cytochrome P450 3A4 (CYP3A4).{{cite journal | vauthors = Sandson NB, Armstrong SC, Cozza KL | title = An overview of psychotropic drug-drug interactions | journal = Psychosomatics | volume = 46 | issue = 5 | pages = 464–494 | year = 2005 | pmid = 16145193 | doi = 10.1176/appi.psy.46.5.464 | s2cid = 21838792 | doi-access = free }} Medications that induce (e.g. carbamazepine) or inhibit (e.g. ketoconazole) CYP3A4 have been shown to decrease and increase, respectively, blood levels of ziprasidone.{{cite journal | vauthors = Miceli JJ, Anziano RJ, Robarge L, Hansen RA, Laurent A | title = The effect of carbamazepine on the steady-state pharmacokinetics of ziprasidone in healthy volunteers | journal = British Journal of Clinical Pharmacology | volume = 49 | issue = Suppl 1 | pages = 65S–70S | year = 2000 | pmid = 10771457 | pmc = 2015057 | doi = 10.1046/j.1365-2125.2000.00157.x }}{{cite journal | vauthors = Miceli JJ, Smith M, Robarge L, Morse T, Laurent A | title = The effects of ketoconazole on ziprasidone pharmacokinetics--a placebo-controlled crossover study in healthy volunteers | journal = British Journal of Clinical Pharmacology | volume = 49 | issue = Suppl 1 | pages = 71S–76S | year = 2000 | pmid = 10771458 | pmc = 2015056 | doi = 10.1046/j.1365-2125.2000.00156.x }}

Its biological half-life time is 10 hours at doses of 80–120 milligrams.

Ziprasidone is chemically similar to risperidone,{{Cite book | url=https://books.google.com/books?id=Sd6ot9ul-bUC&pg=PA465 | title=Foye's Principles of Medicinal Chemistry| isbn=9781609133450| vauthors = Lemke TL, Williams DA | date=January 24, 2012| publisher=Lippincott Williams & Wilkins}} of which it is a structural analogue.{{cite journal | vauthors = Farah A | title = Atypicality of atypical antipsychotics | journal = Primary Care Companion to the Journal of Clinical Psychiatry | volume = 7 | issue = 6 | pages = 268–274 | year = 2005 | pmid = 16498489 | pmc = 1324958 | doi = 10.4088/pcc.v07n0602 }}

It was first synthesized in 1987 at the Pfizer central research campus in Groton, Connecticut.{{cite book| vauthors = Newcomer JW, Fallucco EM | veditors = Schatzberg AF, Nemeroff CB |title=The American Psychiatric Publishing textbook of psychopharmacology|date=2009|publisher=American Psychiatric Pub.|location=Washington, D.C.|isbn=9781585623099|page=641|edition=4th|chapter-url=https://books.google.com/books?id=Xx7iNGdV25IC&pg=PA641|chapter=Ziprasidone}}

Phase I trials started in 1995.{{cite web|title=Approval Package For: Application Number 20-919|url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2002/20-919_geodon_biopharmr.pdf|publisher=FDA Center For Drug Evaluation And Research|date=May 26, 1998}} In 1998 ziprasidone was approved in Sweden.{{cite web|url=http://www.thepharmaletter.com/article/first-approval-for-pfizer-s-zeldox|title=First Approval For Pfizer's Zeldoxs|website=The Pharma Letter|access-date=October 15, 2016}}{{cite web|url=http://www.thepharmaletter.com/article/pfizer-s-zeldox-approvable-in-usa|title=Pfizer's Zeldox approvable in USA – Pharmaceutical industry news | date = September 13, 2000 |work = The Pharma Letter |access-date=October 15, 2016}} After the FDA raised concerns about long QT syndrome, more clinical trials were conducted and submitted to the FDA, which approved the drug on February 5, 2001.{{cite web|title=FDA Background On ZeldoxTM (ziprasidone hydrochloride capsules) Pfizer, Inc. | author = PsychoPharmacological Drugs Advisory Committee | work = Center for Drug Evaluation and Research (CDER) | publisher = U.S. Food and Drug Administration | date = July 19, 2000 |url=https://www.fda.gov/ohrms/dockets/ac/00/backgrd/3619b1b.pdf | archive-url = https://web.archive.org/web/20070714081841/https://www.fda.gov/ohrms/dockets/ac/00/backgrd/3619b1b.pdf | archive-date = July 14, 2007 }}{{cite web|url=http://www.prnewswire.com/news-releases/pfizer-to-launch-zeldox-in-9-european-union-countries-beginning-next-month-76154202.html|title=Pfizer to Launch Zeldox in 9 European Union Countries Beginning Next Month|work = Pfizer Inc| via = prnewswire.com|access-date=October 16, 2016}}

In September 2009, the U.S. Justice Department announced that Pfizer had been ordered to pay a historic fine of $2.3 billion as a penalty for fraudulent marketing of several drugs, including Geodon.{{cite web|url=https://www.justice.gov/opa/pr/justice-department-announces-largest-health-care-fraud-settlement-its-history|title=Justice Department Announces Largest Health Care Fraud Settlement in Its History|website=justice.gov|access-date=October 6, 2016|date=September 2, 2009}}

In the US, Geodon is marketed by Viatris after Upjohn was spun off from Pfizer.{{cite web | title=Pfizer Completes Transaction to Combine Its Upjohn Business with Mylan | publisher=Pfizer | via=Business Wire | date=November 16, 2020 | url=https://www.businesswire.com/news/home/20201116005378/en/ | access-date=June 17, 2024}}{{cite web | title=Geodon | website=Pfizer | url=https://www.pfizer.com/products/product-detail/geodon | access-date=June 17, 2024}}{{cite web | title=Brands | website=Viatris | date=November 16, 2020 | url=https://www.viatris.com/en/products/brands | access-date=June 17, 2024}}

{{Clear}}

Ziprasidone has been studied in and reported to be effective in the treatment of borderline personality disorder, but findings are mixed.{{cite journal | vauthors = Del Casale A, Bonanni L, Bargagna P, Novelli F, Fiaschè F, Paolini M, Forcina F, Anibaldi G, Cortese FN, Iannuccelli A, Adriani B, Brugnoli R, Girardi P, Paris J, Pompili M | title = Current Clinical Psychopharmacology in Borderline Personality Disorder | journal = Curr Neuropharmacol | volume = 19 | issue = 10 | pages = 1760–1779 | date = 2021 | pmid = 34151763 | pmc = 8977633 | doi = 10.2174/1570159X19666210610092958 | url = | quote = Ziprasidone. This atypical antipsychotic has an affinity with serotonin 5HT2A, 5HT1B, and dopamine D2 receptors [31]. Ziprasidone at a daily dose of 80 mg for the treatment of BPD patients proved to be effective in the control of anger, paranoid ideation, impulsivity, and emotional instability, but not for anxiety and depressive symptoms [62]. The use of ziprasidone (daily dose range of 40–160 mg) could be considered for managing acute cases of BPD, considering the reported improvements of suicidal and self-injurious risk, hostility and aggression, impulse control, and severe anxious depressive symptoms [63].}}{{cite journal | vauthors = Stoffers J, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K | title = Pharmacological interventions for borderline personality disorder | journal = Cochrane Database Syst Rev | volume = | issue = 6 | pages = CD005653 | date = June 2010 | pmid = 20556762 | pmc = 4169794 | doi = 10.1002/14651858.CD005653.pub2 | url = }}{{cite journal | vauthors = Pascual JC, Soler J, Puigdemont D, Pérez-Egea R, Tiana T, Alvarez E, Pérez V | title = Ziprasidone in the treatment of borderline personality disorder: a double-blind, placebo-controlled, randomized study | journal = J Clin Psychiatry | volume = 69 | issue = 4 | pages = 603–608 | date = April 2008 | pmid = 18251623 | doi = 10.4088/jcp.v69n0412 | url = }}{{cite journal | vauthors = Pascual JC, Oller S, Soler J, Barrachina J, Alvarez E, Pérez V | title = Ziprasidone in the acute treatment of borderline personality disorder in psychiatric emergency services | journal = J Clin Psychiatry | volume = 65 | issue = 9 | pages = 1281–1282 | date = September 2004 | pmid = 15367057 | doi = 10.4088/jcp.v65n0918b | url = }}

{{Reflist}}

• {{cite book | vauthors = Taylor D | title = Schizophrenia in Focus | url = https://books.google.com/books?id=CyEUUKDScOIC&pg=PA123 | access-date = May 13, 2012 | year = 2006 | publisher = Pharmaceutical Press | isbn = 978-0-85369-607-0 | page = 123}}

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