[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Second-generation antipsychotics](https://durgical.com/en/pharmacology/classes/second-generation-antipsychotics/) › Ziprasidone

# Ziprasidone

## Second-generation antipsychotics?

Second-generation antipsychotics

A second-generation antipsychotic for schizophrenia and bipolar mania that prolongs the QT interval. Taken with food; never with other QT-prolonging drugs.

Updated Nov 12, 2026

## Quick facts

**Group**
[Second-generation antipsychotics](https://durgical.com/en/pharmacology/classes/second-generation-antipsychotics/)

**Target**
Dopamine D2 and serotonin 5-HT2A receptors; also binds the noradrenaline transporter (shown)

**Used for**
Schizophrenia in adults · Manic or mixed episodes

**Key effects**
Sleepiness · Dizziness on standing · Nausea

**Monitor**
Baseline potassium and magnesium · Weight

**ATC**
N05AE04

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◎**Dopamine D2 and serotonin 5-HT2A receptors; also binds the noradrenaline transporter (shown)**Ziprasidone

ⓘ The figure shows ziprasidone bound to the human noradrenaline transporter, a secondary target; its main antipsychotic targets are the D2 and 5-HT2A receptors.

**Target in 3D:** Dopamine D2 and serotonin 5-HT2A receptors; also binds the noradrenaline transporter (shown). PDB structure 8WTY (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/8WTY) · Drag to rotate · pinch to zoom

Ziprasidone blocks dopamine D2 and serotonin 5-HT2A receptors, reducing psychotic symptoms and mania with fewer extrapyramidal effects than first-generation drugs. It also binds the noradrenaline transporter (the structure shown). It delays cardiac repolarisation and prolongs the QT interval, which is why other QT-prolonging drugs are contraindicated.

- Blocks D2 and 5-HT2A receptors
- Also binds the noradrenaline transporter
- Psychosis and mania settle
- Delays cardiac repolarisation: longer QT

## Indications

- Schizophrenia in adults [Schizophrenia →](https://durgical.com/en/conditions/schizophrenia/)
- Manic or mixed episodes of bipolar I disorder, and maintenance with lithium or valproate [Bipolar disorder →](https://durgical.com/en/conditions/bipolar-disorder/)

## Adverse effects

### Common

- Sleepiness, headache, restlessness
- Dizziness on standing
- Nausea, constipation or diarrhoea
- Runny nose, cough
- Raised prolactin: breast changes, missed periods

### Serious (rare, important)

- QT prolongation and torsades de pointes; fainting
- Severe skin reactions, including DRESS and Stevens–Johnson syndrome
- Higher death and stroke risk in older people with dementia (boxed warning)
- Neuroleptic malignant syndrome; tardive dyskinesia; priapism

## Contraindications

- History of QT prolongation, including congenital long QT syndrome
- Recent acute myocardial infarction or uncompensated heart failure
- Other QT-prolonging drugs (for example dofetilide, sotalol, quinidine, pimozide, moxifloxacin, pentamidine)

## Key interactions

**QT-prolonging drugs**
Additive QT prolongation and arrhythmia; contraindicated.

**Diuretics or anything causing low potassium or magnesium**
Raises the risk of torsades de pointes.

**Alcohol and CNS depressants**
More drowsiness.

## What is monitored

- Baseline potassium and magnesium, corrected before starting
- ECG when there are cardiac risks; stopped if the QTc stays markedly prolonged
- Rash with fever or swollen glands
- Weight, glucose and lipids

## Administration and safety

- Oral capsule twice a day with food, swallowed whole.
- Every new medicine is checked for QT prolongation.
- An intramuscular form exists for acute agitation in hospital.

## Pregnancy and breastfeeding

Newborns exposed in the third trimester may have extrapyramidal or withdrawal symptoms; it may also cause problems in breastfed infants.

## Nursing care

- Before: check potassium, magnesium and the cardiac history.
- During: report palpitations, fainting or dizziness at once.
- Watch the skin for rash, blisters or mouth sores with fever.
- Teach to take with meals and to rise slowly.

## Pharmacokinetics

**Absorption**
Oral capsule; food roughly doubles absorption. An intramuscular form is used for acute agitation.

## Memory aid

ZIPrasidone ZIPs out the QT: check potassium and magnesium, take it with a meal, and add no other QT drug.

## Test yourself

Think of the answer, then tap the question to see it.

## Which ECG change limits ziprasidone use?

QT prolongation, with a risk of torsades de pointes.

## Which two electrolytes are checked before starting it?

Potassium and magnesium.

## What must be checked in every other medicine before ziprasidone is started?

Whether it also prolongs the QT interval; such combinations are contraindicated.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/ziprasidone/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 3

- [Lurasidone](https://durgical.com/en/pharmacology/lurasidone/)
- [Quetiapine](https://durgical.com/en/pharmacology/quetiapine/)
- [Risperidone](https://durgical.com/en/pharmacology/risperidone/)

## Related conditions 2

- [Schizophrenia](https://durgical.com/en/conditions/schizophrenia/)
- [Bipolar disorder](https://durgical.com/en/conditions/bipolar-disorder/)

[← Back to the class: Second-generation antipsychotics](https://durgical.com/en/pharmacology/classes/second-generation-antipsychotics/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Ziprasidone: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a699062.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [ZIPRASIDONE HYDROCHLORIDE capsule](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0721cc7e-9560-4ca4-95e1-5c3a4d32c572) (DailyMed (U.S. National Library of Medicine), 2021); [Cryo-EM structure of noradrenaline transporter in complex with ziprasidone](https://www.rcsb.org/structure/8WTY) (RCSB Protein Data Bank, 2024); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N05AE04) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/ziprasidone/