Starting ziprasidone at 20 mg vs 40 mg

[nexus73]

I can't remember the details, but has it been recommended to start ziprasidone at 40 mg BID instead of 20 mg BID? I seem to recall the 20 mg BID was associated with more side effects, like akathisia?

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[Sushirolls]

Never seen/heard that before.

 

[calvnandhobbs68]

Never seen/heard that before.

Stahls does mention it

 

[psyguru]

In a FQHC I work at, many patients with bipolar depression can't afford latuda and seroquel i has the metabolic issues. I will try geodon for bipilar depressinon as there is some indication it maybe effective regardless of lacking the FDA indication for this. With some of my patients, it does seem to work.

 

[Psychresy]

In a FQHC I work at, many patients with bipolar depression can't afford latuda and seroquel i has the metabolic issues. I will try geodon for bipilar depressinon as there is some indication it maybe effective regardless of lacking the FDA indication for this. With some of my patients, it does seem to work.

Isn't there negative evidence for this per canmat?

 

[Merovinge]

I actually prefer 40mg PC dinner, unless that is too sedating and then we setup a big nighttime snack and dose QHS. I have a number of adolescents who tolerate up to 80mg once daily. I often find a need to backload even with BID meals dosing (e.g. 40mg daily and 80pcdinner) due to some level of sedation.

 

[FatherPsychiatry]

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.

 

[Copper_Tracker]

Imo its underutilized. I get that taking it with a meal can be annoying, but the side effect profile is generally favorable and it has utility in not only psychosis/depression, but also anxiety.