The rare times I use ziprasidone, I start at 40mg BID and quickly ramp up to 160mg daily or more. But I work in a state hospital with civilly committed patients long term (3+ months at the minimum, average 1+ year) so issues like sedation are not that problematic, and staff can ensure the med is given around meal time. I really only give it to borderlines if they demand it to foster some therapeutic alliance and empower them, which hopefully reduces their anger outbursts, which is the primary goal anyways.