Geodon: Uses, dosage, side effects, warnings & patient reviews

What is Geodon (Ziprasidone)?

Geodon is the brand name for the medication ziprasidone. It belongs to a class of drugs known as atypical antipsychotics, which are used to manage certain mental health conditions. For a broader understanding of this medication class, you can read about antipsychotic medicines.

Ziprasidone is thought to work by affecting the activity of neurotransmitters in the brain, particularly dopamine and serotonin. It acts as an antagonist at dopamine D2 and serotonin 5-HT2A receptors and has additional effects on other serotonin receptors. This pharmacological profile differs from other antipsychotics, such as quetiapine (Seroquel).

The medication is available in two formulations: oral capsules (e.g., Geodon 20 mg, 40 mg, 60 mg, 80 mg) and an injectable form for use in acute agitation. Generic versions of ziprasidone are also available.

How to Take Geodon

Adherence to specific administration guidelines is critical for the effectiveness and safety of Geodon. The dosing instructions provided here are general; always follow the precise directions from your prescribing physician.

Administration with Food

Geodon capsules must be taken with a meal containing at least 500 calories. Taking the medication without food can reduce its absorption by up to 50%, significantly decreasing its effectiveness. This is a non-negotiable requirement for oral therapy.

Dosage Schedule

The oral dosage is typically divided into two daily doses (morning and evening). The initial dose is often low and is gradually increased by a healthcare provider based on individual response and tolerability. Do not adjust your dose or stop taking Geodon without consulting your doctor, as abrupt discontinuation can lead to a return of symptoms.

Injectable Form

Geodon injection is reserved for the acute treatment of agitation in patients with schizophrenia. It is administered intramuscularly by a healthcare professional. Oral therapy should replace the injectable form as soon as clinically possible.

Side Effects of Geodon

All medications can cause side effects. The following table categorizes potential adverse reactions associated with ziprasidone based on reported frequency and clinical significance.

Antipsychotic use is associated with metabolic changes. Patients should be monitored for potential metabolic syndrome risk factors, such as weight gain, increased blood sugar, and altered cholesterol, although the risk with ziprasidone is generally lower than with some other agents.

What is Geodon Used For?

Geodon is prescribed for the following FDA-approved indications:

• Treatment of Schizophrenia: Geodon is indicated for the management of symptoms of schizophrenia in adults. It is used to treat both acute episodes and for maintenance therapy.
• Treatment of Bipolar I Disorder: Geodon is indicated for the acute treatment of manic or mixed episodes associated with bipolar I disorder in adults, either as monotherapy or as an adjunct to lithium or valproate. It is also indicated for maintenance treatment to delay recurrence of mood episodes.

Geodon is not approved for the treatment of dementia-related psychosis. Its use in children and adolescents is limited and must be determined by a specialist. Any other use is considered off-label and should only be undertaken under the direct supervision of a qualified psychiatrist.

Important Safety Concerns and Considerations

QT Prolongation and Cardiac Risk

Ziprasidone causes dose-related prolongation of the QT interval on an electrocardiogram (ECG). This effect can increase the risk of developing a potentially fatal abnormal heart rhythm known as torsade de pointes. The risk is higher in patients with pre-existing heart disease, a personal or family history of long QT syndrome, electrolyte imbalances (e.g., low potassium or magnesium, which can be caused by diuretics like furosemide (Lasix)), or who are taking other QT-prolonging drugs. Geodon is contraindicated in patients with a known history of QT prolongation or recent acute myocardial infarction.

Increased Mortality in Elderly Patients with Dementia-Related Psychosis

Geodon carries a Boxed Warning (the strongest FDA warning) regarding increased mortality in elderly patients with dementia-related psychosis. Analyses of placebo-controlled trials showed a risk of death approximately 1.6 to 1.7 times higher in drug-treated patients. The causes of death were primarily cardiovascular or infectious. Geodon is not approved for this patient population.

Neuroleptic Malignant Syndrome (NMS)

NMS is a rare but life-threatening neurological disorder associated with antipsychotic drugs. Symptoms include hyperpyrexia (high fever), muscle rigidity, altered mental status, autonomic instability (irregular pulse/blood pressure), and elevated creatine phosphokinase. Immediate discontinuation of the drug and intensive symptomatic treatment are required.

Tardive Dyskinesia (TD)

TD is a syndrome of potentially irreversible, involuntary, dyskinetic movements that may develop in patients treated with antipsychotic medications. The risk appears to be greater in elderly patients, especially women, and with long-term use. If signs of TD appear, discontinuation of Geodon should be considered.

Critical Warnings for Geodon Use

Boxed Warning: Elderly Patients with Dementia-Related Psychosis

Geodon is not approved for the treatment of dementia-related psychosis. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. This risk was observed in analyses of placebo-controlled trials with various atypical antipsychotics.

Contraindications

Geodon is contraindicated in patients with:

• A known history of QT prolongation (including congenital long QT syndrome).
• Recent acute myocardial infarction.
• Uncompensated heart failure.
• Concomitant use with other drugs that have demonstrated QT prolongation.
• Known hypersensitivity to ziprasidone.

Metabolic Changes

Hyperglycemia and diabetes mellitus have been reported in patients treated with atypical antipsychotics. Patients with risk factors for diabetes should undergo baseline and periodic fasting blood glucose testing. All patients should be monitored for symptoms of hyperglycemia.

Dyslipidemia

Undesirable alterations in lipids have been observed in patients treated with atypical antipsychotics. Appropriate clinical monitoring is recommended.

Weight Gain

Weight gain has been observed with antipsychotic use. While ziprasidone is generally associated with less weight gain than some other agents, monitoring of body weight is advisable.

Suicidal Thoughts and Behaviors

Depression and other psychiatric disorders are themselves associated with an increased risk of suicide. Close supervision of high-risk patients should accompany drug therapy, particularly at the beginning of treatment and during dose changes.

Geodon Dosage Information

Dosage must be individualized and titrated under the direct supervision of a healthcare provider. The following table outlines general dosage ranges; the prescriber’s specific instructions must be followed.

Drug Interactions with Geodon

Geodon has a significant number of clinically important drug interactions. The following table summarizes key interactions, but a comprehensive review of all concomitant medications with the prescriber is essential.

Additional Information

Storage and Handling

Store Geodon capsules and the injection vials at room temperature between 20°C to 25°C (68°F to 77°F). Excursions are permitted between 15°C and 30°C (59°F and 86°F). Keep the medication in its original container, tightly closed, and out of reach of children and pets. Protect from light and moisture.

Availability and Forms

Geodon (ziprasidone) is available as:

• Oral Capsules: 20 mg, 40 mg, 60 mg, and 80 mg.
• Intramuscular Injection: 20 mg/mL single-dose vials (requires reconstitution).

Generic ziprasidone capsules are available. The injection is only available as the brand-name product.

Monitoring Requirements

Treatment with Geodon typically involves regular monitoring by a healthcare provider. This may include:

• Assessment of treatment response and side effects.
• Monitoring of weight and metabolic parameters (e.g., blood glucose, lipid profile).
• Periodic evaluation of electrolyte balance, especially potassium and magnesium.
• Baseline and periodic electrocardiogram (ECG) monitoring in patients with cardiac risk factors.

References and Medical Sources

The information on this page is based on official prescribing information and clinical guidelines.

1. U.S. Food and Drug Administration (FDA). Geodon (ziprasidone) Prescribing Information. [Revised May 2022]. https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/020825s054%2C020919s041%2C021483s014lbl.pdf
2. MedlinePlus. Ziprasidone. U.S. National Library of Medicine; [Updated September 2022]. https://medlineplus.gov/druginfo/meds/a699062.html
3. American Psychiatric Association (APA). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. 3rd ed. 2021.
4. Yatham, L. N., et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders. 2018;20(2):97-170.

Disclaimer: The information on this site is provided for informational purposes only and is not medical advice. It does not replace professional medical consultation, diagnosis, or treatment. Do not self-medicate based on the information presented on this site. Always consult with a doctor or other qualified healthcare professional before making any decisions about your health.