Geodon (Ziprasidone) Drug Information

In 2001, the Food and Drug Administration (FDA) approved the antipsychotic drug Geodon (ziprasidone) for the treatment of schizophrenia. The approval was extended in 2004 to include acute manic or mixed episodes of bipolar I disorder (the more severe form of the disease). In 2009, Geodon received further FDA approval for use as a daily maintenance therapy for bipolar I disorder in combination with other traditional bipolar drugs.

Geodon belongs to a class of medications known as atypical antipsychotics, which work by altering the activity of neurotransmitters in the brain.

Geodon Indications

Geodon is indicated for adults with the following conditions:

• Schizophrenia, taken either as an oral medication for general treatment or as an intramuscular injection for acute episodes of agitation
• Acute manic or mixed episodes of bipolar I disorder
• Bipolar I disorder, where it is used for maintenance therapy with either lithium or valproate when acute symptoms have been controlled

Geodon Dosage

The dosage of Geodon varies according to the condition being treated. Geodon capsules are available in four formulations: 20 milligrams (mg), 40mg, 60mg, and 80mg. Geodon injections are available in a single-dose vial to be reconstituted with sterile water for a total of 20mg of ziprasidone.

The recommended dosages of Geodon based on the condition are:

• Schizophrenia: Start with 20mg capsules twice daily, increasing to a daily dose of no more than 80mg twice daily. The lowest effective dose should be used.
• Acute manic/mixed episodes of bipolar I disorder: Start with 40mg capsules twice daily. Increase to 60mg or 80mg twice daily on day two of treatment. Subsequent adjustments should be made based on tolerability, maintaining the lowest effective dose.
• Maintenance of bipolar I disorder: Continue treatment at the same oral dose used to stabilize the acute manic/mixed episode. When used for this purpose, Geodon must be co-administered with either lithium or valproate.
• Acute agitation associated with schizophrenia: Start with a 10mg to 20mg injection delivered intramuscularly (into a muscle), up to a maximum of 40mg per day. Dosages of 10mg can be delivered every two hours. Dosages of 20mg can be delivered every four hours.

Capsules should be taken orally with food. Be sure not to open, crush, or chew the capsules.

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your prescribing doctor to make sure you are taking the right dose for you.

Geodon Side Effects

All antipsychotic drugs will have side effects, ranging from mild to intolerable. Make sure to thoroughly discuss possible side effects with your prescribing doctor. Common side effects of Geodon use include:

• Constipation
  
• Cough
• Diarrhea
• Dizziness
• Fatigue
• Nausea
• Restlessness
• Runny nose
• Sleepiness

Extrapyramidal symptoms, including tremors, shuffling, rocking, muscle rigidity, and involuntary movements (dystonia), are common with all antipsychotic drugs. Of the 15 antipsychotics currently approved for treatment, Geodon ranked eighth in the potential for extrapyramidal symptoms according to a 2013 study from Germany.

Geodon may also trigger an allergic reaction in some people. In rare instances, this could lead to a potentially life-threatening, all-body reaction known as anaphylaxis.

Geodon Warnings

Geodon is not approved for the treatment of dementia-related psychosis in older adults. In fact, the FDA issued a black box warning advising patients and health professionals of the increased risk of death in this population of adults. Most deaths were caused by either a cardiovascular event or an infection. The same warning has been issued with other antipsychotic drugs.

There is also a slight risk (roughly one in 4,000) that Geodon could trigger a potentially fatal change in heart rhythm, known as arrhythmia, leading to sudden death. As such, you should not take Geodon if you had a recent heart attack or have been diagnosed with severe heart failure, long QT syndrome, or certain heart rhythm disorders.

Geodon Drug Interactions

Geodon is contraindicated for use with any drug that affects the QT interval of the heart. These include:

• Avelox (moxifloxacin)
• Betapace (sotalol)
• Mellaril (thioridazine)
• Orap (pimozide)
• Quinidex (quinidine)
  
• Tikosyn (dofetilide)
  
• Zagam (sparfloxacin)

Geodon should also not be used with any medication used to treat arrhythmia, including:

• Pacerone (amiodarone)
• Procan (procainamide)
• Rythmol (propafenone)
• Tambocor (flecainide)
• Tonocard (tocainide)

Carbamazepine, an anticonvulsant drug sold under the brand names Tegretol and others, can reduce the effectiveness of Geodon by as much as 35%. As such, carbamazepine may need to be substituted for another drug if you are also taking Geodon.

Potential Advantages

One of the more exciting aspects of this novel antipsychotic drug is that, unlike earlier generation medications, Geodon is not associated with weight gain.

In an eight-week, head-to-head comparison study, Geodon performed just as well as Zyprexa (olanzapine) in alleviating symptoms of psychosis, including:

• Delusions
• Hallucinations
  
• Paranoia
• Withdrawal

However, it did so with a mean weight gain of less than half a pound compared to a mean gain of almost 15 pounds with Zyprexa. Moreover, unlike Zyprexa, Geodon did not cause an increase in cholesterol and other blood lipids.

These results suggest that Geodon is not only a "healthier" alternative but may decrease the risk of treatment termination due to weight gain.

Other Considerations

As ziprasidone is primarily cleared from the body via the liver, Geodon may exacerbate any preexisting liver condition. This is especially true for people with cirrhosis in whom Geodon may increase liver impairment. If used, your doctor will need to monitor your liver enzymes to avoid liver toxicity and damage.

Geodon may have negative effects during pregnancy. Infants exposed to antipsychotics during the third trimester may experience extrapyramidal symptoms and withdrawal, and animal studies have shown that Geodon may carry an increased risk of adverse events.

However, the potential benefits of taking Geodon may outweigh the potential risks, so speak with your prescribing doctor if you are pregnant or planning to become pregnant.

Before starting Geodon, advise the doctor if you:

• Have a family history of heart disease
• Have ever had problems with dizziness or fainting
• Have ever had liver problems
• Are pregnant, breastfeeding, or intend to get pregnant
• Have allergies to any medications

Do not drink alcoholic beverages while taking Geodon as this can exacerbate symptoms of dizziness or fainting.