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Table 3 Ziprasidone dosing recommendations* [9, 109, 163]

From: Evidence review and clinical guidance for the use of ziprasidone in Canada

  Start dose & titration rate Target dose range Maximum dose
Schizophrenia (adults) 20-40 mg twice daily 60-80 mg twice daily 100 mg twice daily
↑ every 1–3 days
Bipolar mania (adults) 40 mg twice daily 60-80 mg twice daily 80 mg twice daily
↑ every 1–2 days
Elderly No differences in the pharmacokinetics of ziprasidone were observed in a small study involving healthy elderly patients. A limited number of elderly with schizophrenia were exposed to ziprasidone in clinical trials who demonstrated similar tolerability as adults. These findings suggest that reduced dosing may not be necessary unless other considerations are present. Ziprasidone, like other atypical antipsychotics, is not indicated for elderly patients with dementia due the elevated risk of death.
Children There is limited experience with ziprasidone in children under clinical trial conditions, as such data to support its safety and efficacy at any dose is insufficient. Mean dose is one small RCT in children (11.5 y) with tics was ~30 mg/day. In a larger RCT of older children & adolescents (13.6 y) with bipolar disorder, the mean dose was 120 mg/day in those weighing >45 kg.
Special populations Dosage adjustments are generally not required on the basis of gender, race, or renal function. Dose reduction of 40-50% is recommended in the presence of severe hepatic insufficiency and of 20-30% in adolescents, first episode psychosis, organic brain syndrome, bipolar maintenance, underweight, and Asian ethnicity.
Potent inhibitors and inducers of CYP3A4 Dose modification of ziprasidone may be warranted. Pharmacokinetic studies demonstrate the potential for an estimated 30-40% change in systemic exposure to ziprasidone when co-administered with potent CYP3A4 inhibitors (e.g., clarithromycin, protease inhibitors, ketoconazole) and inducers (e.g., carbamazepine, St John’s wort).
  1. * All doses to be taken with a meal of at least 500 kcal to ensure adequate and consistent absorption.