Geodon expired as a brand name for ziprasidone in 2017, and was later rebranded under the name Zeldox outside the US. Today Geodon is commonly available in its generic form, ziprasidone. Manufactured in both tablet and injectable forms, ziprasidone is a potent antipsychotic medication that has been around since 2001.
We will focus on the long-term effects described below that are associated with the oral tablet form. There is a lot to learn, and you may find some information disturbing. But please know ATMC has a good track record of success in recovery after long-term antipsychotic prescriptions.
Are there Other Options Besides a Lifetime of Medication?
We would like to invite you to review the documents that cover ATMC’s high rates of success. The report assessed years of outcomes achieved by the very wide range of client profiles we have helped, stretching now over nearly 2 decades. Each person is a unique individual with distinct needs and treatment goals. ATMC staff design a program tailored to the needs of the client. Using safe medication tapering protocols, orthomolecular and environmental medicine, and many adjunctive therapies for support, we have helped thousands of clients enjoy improved mental health by eliminating or reducing medication to the lowest level that still provides good quality of life.
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What do we Know about the Risks and Long-term Effects of Ziprasidone?
The oral tablet form of ziprasidone is likely to be prescribed long-term, despite the fact that no long-term studies were done prior to approval. The risks for the injectable form are unknown, as no trials were done for longer than 3 days. Over time, knowledge has emerged about the long-term adverse effects of this atypical antipsychotic medication.
We also know that researchers went to jail for manipulating ziprasidone clinical trial outcomes. The drug manufacturer has paid over $2 billion in lawsuit settlements regarding false advertising and safety claims about ziprasidone. And, perhaps the most shocking statement on the drug’s label is that how it works is officially unknown.2,11-13
What we do know about the long-term effects of ziprasidone, however, comes from regulators and health agencies as shown below. 1-3
Long-term effects of ziprasidone can include:
Tardive dyskinesia (often irreversible)
Increased risk of death in elderly dementia patients/li>
Prolonged abnormal muscle contractions leading to difficulty breathing, swallowing, tongue protrusions, and neck spasms
Weight gain
Abnormal vision
Chills, fever
Asthenia or extreme muscle weakness, tiredness
Sudden drop in blood pressure after standing up
Increased motor vehicle accidents
These may not be all the long-term effects of ziprasidone. If you or a loved one experienced adverse reactions after long-term ziprasidone, your information can be forwarded via the FDA adverse drug reactions reporting system.4
Are there Short-Term Side Effects?
Yes. most of the above ziprasidone side effects were reported in FDA literature after short-term trials that lasted 3 weeks. A high percentage of these adverse reactions occurred at a rate of 2 to 3 times that of the placebo group. Some but not all adverse reactions disappeared after cessation of the drug. The condition known as dystonia, prolonged abnormal contractions of muscles, including neck spasms, tongue protrusion, inability to swallow, and difficulty breathing, tended to occur within the first few days of treatment with ziprasidone in some persons, occurring more frequently in young male persons, according to the studies cited on the drug’s label.
In a bipolar-based pre-marketing trial mentioned in the package insert, participant drop-outs due to adverse effects were most frequently cited due to emergence of akathisia, anxiety, dizziness, dystonia, rash, and vomiting. As the trial was 3 weeks in duration to its completion, these adverse effects would have emerged within a short period of time.2
What is Ziprasidone Prescribed to Treat?
Ziprasidone oral capsules were approved for treating schizophrenia and an injectable form was approved for acute agitation in schizophrenia. Ziprasidone oral was also given approval to treat acute mania episodes in bipolar conditions.
Clinical trials for efficacy varied greatly in their reported outcomes, according to the drug’s label and prescribing guidelines, and who was participating in the trials.
For example, in one 4-week long trial in schizophrenia patients, participants were given either 5mg, 20mg. or 40mg mg doses twice daily, while the control group was given a placebo. There was no difference in outcomes compared to placebo for any of these dosing tiers.
In comparison, a 3-week-long trial was described where bipolar patients with mania were given 132mg daily, and the results showed a decrease in mania symptoms, i.e., lessened insomnia, and a reduction of excessive energy & excitability. A similar result is reported in a 3-week trial with bipolar-mania patients, where the average daily dose was 112mg.
A one-day trial on the intramuscular form of ziprasidone in schizophrenia patients with agitation showed that 20 mg injected doses were more effective at calming the patients than the 2mg injections. The clinical trials mentioned do not provide details beyond these very sparse details.
Does Ziprasidone Carry a Black Box Warning?
Yes. The black box warning on the drug’s packaging includes doubling of mortality rates in elderly patients with dementia related psychosis.
Aside from “black box” warnings, many, many drugs taken concurrently with ziprasidone can cause extreme interactions. One should make very sure their prescriber understands all the drugs a person is taking simultaneously so that injurious drug-drug interactions can be avoided.
Forms and Dosages of Ziprasidone Commonly Prescribed
In the treatment of (unspecified) mania, according to the drug’s label, there are no clinical guidelines that support remaining on ziprasidone longer than 3 weeks, once the mania of bipolar has subsided. The only other clear guidance found was that dosages higher than 160mg day are “not generally recommended.”
Another recommendation is that for bipolar the dosage should be started at 40mg twice daily, then doubled to 80mg twice daily on day 2, and then adjusted from between 40mg – 80mg as treatment continues. The prescriber is advised by the FDA to judge an adjustment of dosage based on efficacy and tolerance.
And perhaps adding additional uncertainty to FDA recommendations given (as such), in a 52-week follow up, it was found that dosages above 20mg twice daily saw no greater benefit. Yet the average dosage in clinical trials was 120mg daily. And the “recommended” dosage as mentioned in the previous paragraph for bipolar patients is quite a bit higher, and is seemingly left up to the prescriber’s judgement.
For the injectable form of ziprasidone, the recommendations are 10mg every 2 hours up to 40mg, or 20mg at 4-hour intervals up to a maximum of 40mg. If further treatment is needed, the recommendation is to immediately switch to oral ziprasidone. Ziprasidone injectable has not been studied beyond 3 days according to the drug label, so its long-term effects are undocumented.
Is Ziprasidone Associated with Negative Effects on the Heart?
Yes. The drug trials consistently showed an impairment of the efficiency of the heart. These effects include prolongation of the QT interval, which means increasing the time it takes for the heart to pulse. Other cardiac issues were a condition known as torsade de pointes, or an abnormal rhythm of the heart and can lead to death due to impaired or weak circulation. Also reported heart issues include tachycardia — which is a faster than normal elevation of heart rate.
Due to these safety concerns, ziprasidone is not recommended for patients with a history of cardiac disease or who may have suspected cardiac issues.
Can Ziprasidone Precipitate Serotonin Syndrome?
Yes. The drug label contains a warning of the possibility of serotonin syndrome whether ziprasidone is taken as monotherapy, or whether it is taken along with other serotonergic drugs. Serotonin syndrome is a potentially life-threatening condition, and has been reported post-marketing as associated with ziprasidone.5-7
Symptoms of serotonin syndrome include sudden fever, mental confusion, tachycardia, agitation, dilated pupils, akathisia, tremor, muscle stiffness, increased bowel activity, and involuntary muscle clenching or contractions. Serotonin syndrome usually occurs within a short time of ingesting the serotonergic agent or drug.
What is Neuroleptic Malignant Syndrome?
NMS or neuroleptic malignant syndrome is a drug-induced reaction that is very similar in presentation to serotonin syndrome. It is thought to be a result of over-activation of dopamine instead of serotonin and is more frequently associated with antipsychotic medications. Serotonin syndrome comes on more quickly than NMS which has a more gradual onset. Another difference between these 2 drug-induced conditions is that serotonin syndrome involves involuntary muscle contractions, where NMS more often presents as muscle rigidity.
Both NMS and serotonin syndrome should be met with medical assistance, and immediate cessation of the drug. This is an important part of the medical consensus on correctly treating these drug-induced outcomes.
Other Ziprasidone Concerns
The integrity of the pharmaceutical industry has crumbled due to years of dishonest practices. Drugmaker Pfizer was found guilty of actively promoting Geodon/ziprasidone for off-label uses. Physicians were encouraged to write prescriptions for mood disorders, dementia, bipolar maintenance treatment, anxiety, depression, and many others because ziprasidone was “safer” than the drugs they were currently prescribing to their patients, including children with autism — for whom ziprasidone was never FDA-approved.
Three of the researchers involved in ziprasidone clinical trials were jailed for manipulating the outcomes of the trials. All three were disbarred from the FDA and 2 researchers did prison time for their misconduct. Pfizer was fined over $2 Billion for false advertising.
Additionally, other lawsuits have also been brought for wrongful death ($33 million) and a class action lawsuit ($400 million). The drug Geodon’s patent expired in 2017, but the drug ziprasidone is still prescribed today. Since the FDA’s 2001 approval was based on false and manipulated information, it is shocking that the drug was not recalled, and the clinical trials were not re-done to ensure public safety.11-13
Notes on Ziprasidone Withdrawal
Withdrawal from an antipsychotic medication needs precise and well-managed care for success. It is quite disturbing that “withdrawal” is mentioned in a tiny footnote on ziprasidone’s label, and no details of what can happen in withdrawal either done fast or slow are given.
One of the most concerning aspects of stopping antipsychotic medication is because of what is called “antipsychotic-induced dopamine super-sensitivity.” Because antipsychotics are thought to hold back or dampen the expression of dopamine, the CNS responds over time by increasing the sensitivity of dopamine receptors. So that when the medication is even slightly reduced, a flood of dopamine can ensue which can be disastrous. Much preparation and support must be in place before antipsychotic medications can be safely reduced or eliminated. This is especially true in long-term antipsychotic use.8-10
If one has been taking ziprasidone long-term one is probably experiencing some of the negative long-term effects of ziprasidone. That doesn’t mean that all of the above listed adverse effects will happen to any one person. The profile of each person is unique. While an antipsychotic medication may have been absolutely needed in a time of crisis, once the crisis has passed, the medication may not be fulfilling any significant benefit. Some persons may feel only mild adverse reactions, and some will be experiencing much more invasive symptoms, and factors such as these may lead to a desire to come off the medication.
ATMC specializes in handling particularly difficult cases, and offers gentle methods of withdrawal and tapering from antipsychotic medications. In many cases, the drug can be safely reduced or even entirely eliminated. Each person’s situation is considered on an individual basis.
As mentioned earlier, many of the long-term effects of ziprasidone diminish or disappear once the drug is withdrawn, but care must be taken so that the medically monitored cessation results in success without relapse of the original symptoms that lead to the drug being prescribed in the first place.
Please call us for a confidential consultation if you or a loved one is considering coming off ziprasidone. We are here to help.
Originally Published September 25, 2025 by Diane Ridaeus
This content has been reviewed and approved by a licensed physician.
Dr. Samuel Lee
Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente. He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.
Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.
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The oral tablet form of ziprasidone is likely to be prescribed long-term, despite the fact that no long-term studies were done prior to approval. The risks for the injectable form are unknown, as no trials were done for longer than 3 days. Over time, knowledge has emerged about the long-term adverse effects of this atypical antipsychotic medication.
In the treatment of (unspecified) mania, according to the drug’s label, there are no clinical guidelines that support remaining on ziprasidone longer than 3 weeks, once the mania of bipolar has subsided. The only other clear guidance found was that dosages higher than 160mg day are “not generally recommended.”
