Geodon (Ziprasidone) Drug Information

Treating Schizophrenia and Bipolar I Disorder

Geodon
Geodon (ziprasidone) — Sold as Zeldox in Canada.

Geodon 

In 2001, the U.S. 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 of Geodon 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 works by altering the activity of neurotransmitters in the brain.

Indications

Geodon is indicated for treatment in adults with the following specific conditions:

  • Schizophrenia, taken either as an oral medication for the general treatment of schizophrenia or as an intramuscular injection for acute episodes of agitation in schizophrenia
  • 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

Dosage

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

The recommended dosage of Geodon is as follows:

  • Schizophrenia: Start with 20-mg capsules twice daily, increasing to a daily dose of no more than 80 mg twice daily. The lowest effective dose should be used.
  • Acute manic/mixed episodes of bipolar I disorder: Start with 40-mg capsules twice daily. Increase to 60 mg or 80 mg twice daily on day 2 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 coadministered with either lithium or valproate
  • Acute agitation associated with schizophrenia: Start with a 10- to 20-mg injection delivered intramuscularly (into a muscle), up to a maximum of 40 mg per day. Dosages of 10 mg can be delivered every two hours. Dosages of 20 mg can be delivered every four hours.

If you miss a dose of Geodon, you can take the dose when you remember. However, you should skip the missed dose if it's almost time for your next dose. You should never double up or take extra doses to make up for missed doses.

Side Effects

All antipsychotic drugs will have side effects, ranging from mild to intolerable. Speak with your doctor in advance of treatment so that you are fully aware of the possible side. Common side effects of Geodon use include:

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

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 allergy known as anaphylaxis.

Call 911 or seek emergency care if you develop hives, rapid heart rate, breathing difficulty, lightheadedness, nausea or vomiting, and the swelling of the face, throat, or tongue after taking Geodon.

Warnings

Geodon is not approved for the treatment of dementia-related psychosis in elderly people. The FDA issued a black box warning advising doctors and patients about the increased risk of death in this population of adults. Most deaths were caused by either a cardiovascular event or 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.

Call 911 or seek emergency care if you faint or experience rapid heartbeats (tachycardia) or abnormal heart rhythms while taking 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)
  • Rhythmol (propafenone)
  • Tambocor (flecainide)
  • Tonocarid (tocainide)

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

Because of its potential for inducing hypotension (low blood pressure), Geodon may enhance the effects of certain drugs used to treat hypertension (high blood pressure).

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 a six-week, head-to-head study, Geodon performed just as well as Zyprexa (olanzapine) in alleviating symptoms of psychosis, including hallucinations, delusions, paranoia, and withdrawal. However, it did so with only a median weight gain of one pound compared to 10 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, any preexisting liver condition may be exacerbated the use of Geodon. 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 is classified as a Category C drug for pregnancy, meaning that there are no adequate clinical studies in humans but that animal studies have shown an increased risk of adverse events. Low birth weight is the most cited concern. As such, the potential benefits of Geodon may outweigh the potential risks, so speak with your doctor.

You should not breastfeed while taking Geodon as there are no studies to determine whether ziprasidone can be transmitted in breast milk and what effect if any, this may have on the baby.

Before starting Geodon, advise your 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.

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