10 Ziprasidone (Geodon) Interactions to Know About

Ziprasidone (Geodon) is part of a group of medications called atypical antipsychotics. It treats mental health conditions like bipolar disorder and schizophrenia. Ziprasidone is available as both an oral capsule and an injection. The oral capsule is taken twice daily with food.

Like all medications, ziprasidone has risks, including drug interactions. Knowing about these risks can help keep you safe while taking ziprasidone. Here, we’ll cover 10 ziprasidone interactions to watch for and how to prevent or manage them.

1. Alcohol

Ziprasidone and alcohol may interact because they can both cause dizziness and drowsiness. This can affect your thinking and coordination. It can also increase your risk of falls and injuries.

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Additionally, drinking alcohol can make some symptoms of mental health conditions worse. For example, alcohol use (especially in large amounts) can make depression worse.

For these reasons, it’s best to avoid drinking alcohol while taking ziprasidone. Be honest with your prescriber if you don’t think you can stop drinking alcohol, though. They can help you access resources to limit your drinking. They may also recommend alternatives to ziprasidone.

If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.

2. Benzodiazepines, such as Xanax

Benzodiazepines (BZDs) are medications that treat health conditions such as anxiety and panic attacks. They’re considered sedatives, which are medications that can slow down and calm the brain. Examples of BZDs include Valium (diazepam), Xanax (alprazolam), and Ativan (lorazepam).

BZDs side effects include drowsiness, trouble with coordination, and forgetfulness. When combined with ziprasidone, these side effects can be more severe. So it’s best to avoid combining BZDs with ziprasidone if possible. However, your prescriber may still decide you need both. In this case, watch for excessive drowsiness, dizziness, and slowed breathing.

3. Opioids, such as oxycodone

Opioids treat pain that can’t be managed by non-opioid medications. Examples of opioids include oxycodone (Roxicodone, OxyContin), the combination medication hydrocodone / acetaminophen, and tramadol (ConZip, Qdolo). This group of medications has sedative-like effects. So taking ziprasidone and opioids together can cause excessive drowsiness and dizziness. And like ziprasidone, opioids can also cause nausea.

EXPERT PICKS: WHAT TO READ NEXT

• What are atypical antipsychotics? An expert explains how these medications work to treat a variety of mental health conditions. 

•  Ziprasidone dosage: Learn how often and when ziprasidone should be taken each day.

• Drowsiness, dizziness, and nausea:  Read more about common side effects of ziprasidone and how to manage them.

Plus, some opioids can cause a heart condition called long QT syndrome. Methadone (Methadose) is one opioid that can increase this risk. Long QT syndrome is a change in your heart rhythm, leading to fast, chaotic heartbeats. Long QT syndrome is rare, but it can be life-threatening. Ziprasidone also increases your risk of long QT syndrome. Taking more than one medication that increases this risk makes it more likely to affect you. Always give your prescriber a list of your medications before starting ziprasidone. They’ll let you know if you need to make any changes to your medications.

It’s best to avoid taking opioids if you’re already taking ziprasidone. If your prescriber does decide you need an opioid, follow their exact instructions for how to take it. Taking opioids incorrectly increases your risk of side effects like drowsiness and dizziness. In severe cases, misuse can cause slowed breathing and overdose.

4. Sleep medications, such as zolpidem

As you might expect, medications that help with sleep cause drowsiness. But combining them with ziprasidone can make you too drowsy.

Examples of sleep medications that may interact with ziprasidone include:

• Z-drugs, such as zolpidem (Ambien, Edluar) and eszopiclone (Lunesta)

• Antihistamines, such as diphenhydramine (Benadryl, ZzzQuil, Unisom SleepGels)

• Orexin receptor antagonists, such as suvorexant (Belsomra) and lemborexant (Dayvigo)

• Melatonin receptor agonists, such as Ramelteon (Rozerem)

Some antidepressants such as doxepin (Silenor, Zonalon) and trazodone are prescribed off-label for sleep.These can cause excessive drowsiness with ziprasidone too. So talk with your prescriber if you take medication to help you sleep. They may suggest a change to your medication regimen before starting ziprasidone. They might also recommend assessing your sleep habits to see if that helps you sleep.

5. Muscle relaxers, such as cyclobenzaprine

Muscle relaxers are another group of medications that can cause drowsiness. That’s why it’s best to avoid ziprasidone if you take muscle relaxers. Examples include cyclobenzaprine (Amrix) and baclofen. If you take ziprasidone, you may need to avoid muscle relaxers. Or your prescriber may recommend taking a lower dose of muscle relaxers for a shorter amount of time. You’ll want to watch for symptoms of excessive drowsiness if you take this combination.

6. Medications that prolong the QT interval, such as Celexa

As mentioned previously, ziprasidone increases your risk of long QT syndrome. So it’s recommended to avoid other medications that also have this risk, including:

• Some antidepressants, such as Celexa (citalopram), and amitriptyline

• Macrolide antibiotics, such as azithromycin (Z-pack)

• Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro)

• Antiarrhythmic medications, such as amiodarone (Pacerone)

• Some nausea medications, such as ondansetron (Zofran)

• Some migraine medications, such as sumatriptan (Imitrex, Tosymra)

• Some opioids, such as methadone

Long QT syndrome can lead to dizziness, heart palpitations, and even death in severe cases. So make sure your prescriber and pharmacist have a list of all the medications you take. They may recommend changes to your medications before starting ziprasidone. 

7. Blood pressure medications, such as amlodipine

Ziprasidone isn’t a blood pressure medication. But it can lower your blood pressure as a side effect. Tell your prescriber if you take other medications that also lower blood pressure. Combining these medications can lower your blood pressure too much.This is called hypotension.

There are many different types of medications that decrease your blood pressure. Medications that treat high blood pressure (hypertension) are the main ones to watch for. Common examples include:

• Calcium channel blockers, such as amlodipine (Norvasc)

• Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril (Zestril)

• Angiotensin II receptor blockers (ARBs), such as losartan (Cozaar)

• Thiazide diuretics, such as hydrochlorothiazide (Microzide)

• Beta blockers, such as metoprolol (Lopressor, Toprol XL)

If you take any of these, your prescriber might tell you to check your blood pressure at home more often. You may need a lower dose of your blood pressure medication to prevent hypotension. But don’t make any changes without talking to your prescriber first.

8. Dopaminergic medications, such as Sinemet

Some medications work by increasing the levels of a chemical called dopamine. These medications treat conditions like Parkinson’s disease and restless leg syndrome. Examples include:

• Ropinirole

• Pramipexole

• Sinemet (carbidopa / levodopa)

• Amantadine (Gocovri)

In contrast, one of the ways ziprasidone works is by decreasing dopamine effects in the brain. So these medications can counteract each other’s effects. This might cause symptoms of Parkinson’s disease and restless leg syndrome to get worse. For example, you could have more problems with movement.

You may need to avoid combining ziprasidone with medications that increase dopamine. But ziprasidone may be a good antipsychotic for people who have Parkinson's disease. This is because it doesn’t affect dopamine as much as other antipsychotics.

Keep in mind that other medications and supplements can increase dopamine. One example is ashwagandha supplements. 

9. Medications that increase ziprasidone levels, such as ketoconazole

Some medications affect how the body metabolizes (breaks down) ziprasidone. Blocking ziprasidone metabolism can cause higher levels of the medication in your body. And this means an increased risk of side effects. Examples of medications that increase ziprasidone levels include ketoconazole and itraconazole (Sporanox). Grapefruit and grapefruit juice can also increase ziprasidone levels.

If you take any of these medications or eat grapefruit, let your prescriber know. They may recommend dose adjustments to one or more of your medications.

10. Medications that decrease ziprasidone levels, such as carbamazepine

While some medications can block ziprasidone metabolism, others can speed it up. This leads to lower ziprasidone levels in the body, which can make it less effective. Examples of medications that may interact with ziprasidone in this way include:

• Carbamazepine (Tegretol, Equetro)

• Rifampin (Rifadin)

• Phenytoin (Dilantin, Phenytek)

• St. John’s wort

If you take any of these medications, your prescriber may suggest a dosage change. This will help them make sure ziprasidone is working.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Soojin Jun, PharmD

Soojin has 10 years of experience in various pharmacy settings, from inpatient to outpatient settings, and population health in value-based healthcare models. She completed training in various areas of healthcare to ensure patient safety, from activism, geriatric pharmacy, medication safety, healthcare quality, patient safety, death and dying, and trauma-informed care.

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