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Ziprasidone

(zi pray' si done)

Brand Name(s): Geodon®; also available generically

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.

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: http://www.fda.gov/Drugs

WHY is this medicine 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.

Are there OTHER USES for this medicine?

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

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. It may take a few weeks or longer before you feel the full benefit of ziprasidone. Continue to take ziprasidone even if you feel well. Do not stop taking ziprasidone without talking to your doctor.

What SPECIAL PRECAUTIONS should I follow?

Before taking ziprasidone,

  • tell your doctor and pharmacist if you are allergic to ziprasidone, any other medications, or any of the ingredients in ziprasidone capsules. Ask your pharmacist for a list of the ingredients.

  • tell your doctor if you are taking amiodarone (Cordarone, Pacerone), arsenic trioxide (Trisenox), chlorpromazine, disopyramide (Norpace), dofetilide (Tikosyn), dolasetron (Anzemet), dronedarone (Multaq), droperidol (Inapsine), gatifloxacin (no longer available in the U.S.), halofantrine (Halfan) (no longer available in the U.S.), ibutilide (Corvert), levomethadyl (ORLAAM) (no longer available in the U.S.), mefloquine, mesoridazine (no longer available in the U.S.), moxifloxacin (Avelox), pentamidine (NebuPent, Pentam), pimozide (Orap), probucol (no longer available in the U.S.), procainamide, quinidine (in Nuedexta), sotalol (Betapace, Sorine, Sotylize), sparfloxacin (no longer available in the U.S.), tacrolimus (Astagraf, Prograf), or thioridazine. Your doctor may tell you not to take ziprasidone if you are taking one or more of these medications. Other medications may also interact with ziprasidone, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.

  • 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; medications for anxiety; carbamazepine (Carbatrol, Tegretol, Teril, others); diuretics ('water pills'); dopamine agonists such as bromocriptine (Cycloset, Parlodel), cabergoline, levodopa (in Sinemet), pergolide (Permax) (no longer available in the U.S.), and ropinirole (Requip); ketoconazole (Nizoral); medications for high blood pressure, mental illness, seizures, or anxiety; and sedatives, sleeping pills, or tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

  • tell your doctor if you have heart failure, long QT syndrome (a heart condition that may cause dizziness, fainting, or irregular heartbeat), or if you have recently had a heart attack. Your doctor will probably tell you not to take ziprasidone.

  • tell your doctor if you have or have had thoughts about harming or killing yourself, breast cancer, an irregular heartbeat, a stroke or ministroke, seizures, diabetes, dyslipidemia (high cholesterol levels), trouble keeping your balance, or heart or liver disease. Also, tell your doctor if you low levels of potassium or magnesium in your blood, if you use or have ever used street drugs or have overused prescription medications, or have trouble swallowing. Also tell your doctor if you have severe diarrhea or vomiting or you think you may be dehydrated.

  • tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy, or if you plan to become pregnant or are breastfeeding. If you become pregnant while taking ziprasidone, call your doctor. Ziprasidone may cause problems in newborns following delivery if it is taken during the last months of pregnancy. You should not breastfeed if you are 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.

What should I do IF I FORGET to take 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.

What SIDE EFFECTS can this medicine cause?

Ziprasidone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • headache
  • restlessness
  • anxiety
  • lack of energy
  • constipation
  • diarrhea
  • loss of appetite
  • muscle pain
  • stomach pain
  • runny nose
  • cough
  • weight gain
  • breast enlargement or discharge
  • late or missed menstrual period
  • decreased sexual ability
  • dizziness, feeling unsteady, or having trouble keeping your balance

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 or get emergency medical treatment:

  • unusual movements of your face or body that you cannot control
  • fast, irregular, or pounding heartbeat
  • rash or hives
  • itching
  • blisters or peeling of skin
  • mouth sores
  • swollen glands
  • fever
  • chills
  • shaking
  • muscle stiffness
  • falling
  • confusion
  • sweating
  • loss of consciousness
  • 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 (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature away from light and excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

  • 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.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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