Ziprasidone

How it works

It antagonises dopamine D2 and serotonin 5-HT2A receptors, with additional activity at other serotonergic and adrenergic receptors contributing to its effect.

Prescribing in practice

• It can prolong the QT interval, so it is contraindicated in those with known QT prolongation, recent myocardial infarction or uncompensated heart failure, and caution is needed with other QT-prolonging drugs.
• Oral absorption is substantially enhanced when taken with food, so consistency in administration is important.
• Use with caution in those with risk factors for electrolyte disturbance, which can potentiate arrhythmia risk.

Monitoring

Monitor ECG where there are cardiac risk factors, along with electrolytes, weight and metabolic parameters.

Counselling the patient

• Take the medicine with food to ensure it is absorbed properly.
• Report palpitations, fainting or dizziness without delay.
• Do not stop treatment suddenly without discussing it with your prescriber.

Evidence & guidelines

Atypical antipsychotics are established options for schizophrenia, with choice guided by side-effect profile per NICE guidance.