Geodon (ziprasidone)

Geodon (ziprasidone) is an antipsychotic medication--one of a group called "atypical" to distinguish these newer drugs from older medications. The FDA approved Geodon as a treatment for schizophrenia in 2001. It helps manage schizophrenia's "positive symptoms," such as visual and auditory hallucinations, delusions, and thought disturbances. Geodon may also help in treating the "negative symptoms" of schizophrenia, which include social withdrawal, apathy, lack of motivation, and an inability to experience pleasure. Geodon is associated with little or no weight gain, a characteristic that distinguishes it from other antipsychotic drugs.

How Geodon Works

As with other atypical antipsychotic medications, Geodon may reduce the positive symptoms of schizophrenia by blocking the action of serotonin and dopamine, two neurotransmitter chemicals, at specific chemical receptors in the brain. Geodon also moderately inhibits the reuptake of serotonin and norepinephrine into brain cells, which may improve both depressive and the negative symptoms of schizophrenia.

Safety Issues

Several years ago, the FDA became concerned about the possibility that ziprasidone and a number of other drugs might increase the very small possibility of a specific, potentially fatal heart-rhythm irregularity called torsade de pointes. The FDA did not approve ziprasidone in 1998 because there was some evidence that it could cause a lengthening of the so-called QT interval of the heartbeat, a change associated with torsade. The FDA asked for specific safety data, which were submitted last year. Although "QT prolongation" is still a theoretical concern, more than 4,000 consumers have been treated in clinical trials without evidence of the heart-rhythm irregularity. And the overall mortality rate during the trials was similar to that of placebo and with other antipsychotic drugs.

The FDA labeling does not include a "black-box warning," usually included when there is a significant risk that the doctor must be aware of and take into account when prescribing, and it does not require an EKG prior to or during treatment. However, the labeling warns physicians and consumers about QT prolongation and the possible risk of sudden death. The FDA labeling suggests that doctors use their best judgment, based on the health status of the individual, when considering the use of ziprasidone as a first-line medication or only after other medications have failed. There are no requirements that consumers have regular heart check-ups while taking this medication.

It is important to note that your risk of dangerous heart-rhythm changes can be increased by other medications you may be taking and other heart conditions you may have. Therefore, you should tell your doctor about all your other medications (including supplements and non-prescription and herbal medicines) and any heart problems you have now or have had. If you faint, lose consciousness, or have heart palpitations while taking Geodon, contact your doctor immediately.

Side Effects

Some of the most common side effects associated with Geodon are feeling unusually tired, nausea, constipation, dizziness, restlessness, diarrhea, rash, cough and runny nose, and abnormal muscle movements, including tremor, shuffling, and uncontrollable movements.

Tardive Dyskinesia

Tardive dyskinesia (TD) is a disorder characterized by abnormal movements of the mouth, limbs, or body that occur in some people

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taking antipsychotic drugs. Researchers believe that newer, atypical antipsychotics like Geodon are less likely to cause TD than some older, conventional antipsychotics. Because it may take years until researchers can fully assess the risk of TD when taking Geodon, this drug should be prescribed at the lowest effective dose to minimize that risk. If you develop symptoms of TD while taking Geodon--symptoms such as grimacing, sucking and smacking of your lips, and other abnormal movements of the body or limbs--you and your doctor should consider switching medications. Keep in mind, though, that some people may need to continue taking Geodon to most effectively control their symptoms of schizophrenia despite developing TD.

What Your Doctor Needs To Know

Your physician should decide if Geodon is the best treatment for you. If you are thinking about taking Geodon, be sure to tell you doctor if you:

• have had any problems with your heartbeat or heart disease
• have a family history of heart disease
• have had any problems with fainting or dizziness
• have had any liver problems
• are pregnant or plan to get pregnant
• are breastfeeding
• are taking any prescription or non-prescription medicines
• are allergic to any medications

Geodon Interactions With Other Medications

There are some medications that may be unsafe to use when taking Geodon, and there are some that can affect how well Geodon works. Always tell your doctor about all drugs that you are taking, including non-prescription drugs, supplements, and herbal remedies.

• Geodon should not be taken with any drug that affects the QT interval in a heartbeat, such as thioridazine (Mellaril), quinidine (Quinidex), moxifloxacan (Avelox), pimozide (Orap), and sparfloxacin (Zagam).
• Because Geodon has a direct effect on the central nervous system, people taking this drug should be cautious when taking other drugs that affect the central nervous system.
• Studies have shown that the anticonvulsant carbamazepine (Tegretol) (commonly used as a mood stabilizer to treat bipolar disorder) lessens the effects of Geodon.

Dosage for Geodon

The lowest effective dose of any medication should always be used to reduce the risk of troublesome and potentially harmful side effects. The recommended initial dose of Geodon is 20 mg per day, but this dose may be increased to 80 mg twice a day, depending on its effectiveness in each individual. Increasing the dose beyond 80 mg twice a day is not recommended. Your physician should watch for improvement of your symptoms for several weeks before adjusting the dose because it may take that long for the drug to produce its full effect.

Other Noteworthy Information

Geodon is available in capsules that should be swallowed whole and taken with food. Women who are planning to become pregnant or who are pregnant should discuss both the benefits and risks with their doctor before taking Geodon. In addition, breast-feeding is not recommended for women taking Geodon. Because dizziness caused by a drop in blood pressure can occur while taking Geodon, be careful when standing up and tell your doctor immediately if you feel dizzy.

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