Geodon (Ziprasidone)

When it works, it works the best. When it stops working, you're screwed. At least that's how I remember it...

Used For: Schizophrenia and the manic phase of bipolar disorder.

I used it for schizoaffective disorder, though it may have not been the best medication for this diagnosis in my opinion.

Do Not Use If: You have an abnormality on your electrocardiogram known as QT or QTc prolongation or you are taking medications known to cause this.

I didn't have any heart conditions or known family history of heart problems so I was able to take Geodon.

Tests to Take First: Weight and height should be recorded.

I never took any tests before starting Geodon. I personally don't think recording weight and height is as important with Geodon in comparison to some of the other antipsychotics like Zyprexa, Seroquel, or Risperdal. In fact, I actually lost a little weight while taking Geodon simply by eating healthy and exercising. Geodon didn't seem to be a very appetite-changing medication for me and it even made me a little obsessive about wanting to keep my weight down, which may not have been a bad thing.

Tests to Take While You Are on It: A physical examination called the AIMS test should be performed by the psychiatrist or nurse practitioner at least every six months to detect early signs of tardive dyskinesia. Weight should be monitored monthly.

I actually had to take a test called an EKG I think it was, for my heart while taking Geodon after I kept saying how this drug made me feel like it sped up my heart beat. The results of the test were that my heart beat was fine though.

Usual Dose: Patients usually started at 20 mg twice a day and then the dose can be increased as needed to a maximum of 80 mg twice daily. Geodon also comes in an injectable form for use in emergencies for very agitated or violent patients.

When I was first prescribed Geodon, I took 80mg in the morning and then another 80mg at night. This worked well, but the 80mg in the morning was occasionally sedating (even though this drug felt like it made my heart beat faster) so my old psychiatrist said I could start taking 160mg all at night. And at one point, I was taking 240mg at night which exceeds the usual maximum dose. 240mg all at once made me extremely twitchy sometimes though especially in the limbs, neck, throat, and face. The twitching was fairly bad...

How Long Until It Works: Some decrease in psychotic symptoms, like hallucinations and delusions, may be seen in a matter of hours to days, but the full benefit may take several weeks, particularly if the dose needs to be titrated up, which it frequently does.

I remember when Geodon first started working for me it felt like a cloud lifted from my head, and I felt like I could think clearly for the first time ever. I could feel its effects the next morning, which is usual for antipsychotics to work this fast in my experiences with them. These drugs are faster-working than antidepressants or other medications.

Common Side Effects: Dizziness, constipation, dry mouth, agitation and sedation sometimes occur, but they usually do not last. Weight gain is also possible, but appears to be much less of a problem than with Zyprexa, Seroquel, and Risperdal.

Geodon gave me a lot of bothersome side effects. Most annoying were that it made my heart beat feel funny, it made several parts of my body very twitchy (like that Tweek kid on South Park), and it also was sometimes very sedating yet at other times very awakening, which is the first time I've ever encountered a med that did this. One thing I also remember about Geodon which was a good thing is that it had no effect on my bowel movements meaning I had no diarrhea or no constipation which I know sounds kinda insignificant, but when you've been on psychiatric meds for years and are likely going to be on them for the rest of your life, you experience a lot of diarrhea and constipation over the years and it gets real annoying really quickly.

Less Common Side Effects: As mentioned above, it is possible that ziprasidone will cause tardive dyskinesia, but the risk of this is much less than with older antipsychotic drugs like Haldol and Prolixin. Also, in elderly patients with dementia there is said to be an increased risk of death, usually from heart problems or infections.

The side effects I experienced with Geodon never went away, then one day, like the snap of a finger, the side effects just suddenly amplified to a much severe degree. While the positive effects of this drug (reducing symptoms of psychosis) completely stopped working. So basically, Geodon was working very well for me then...Boom!! Side effects became worse and paranoia & everything even returned too. It was like a double-whammy-blindside. Oh yea, I must mention that while I was on Geodon about once every 6 months I wouldn't be able to fall asleep at all until the next night.

What to Do About Side Effects: Very few side effects of Geodon are severe and most go away on their own. Sometimes a reduction in dose is needed. If agitation is a problem, antianxiety drugs like Valium or Klonopin or the atyipical antipsychotic drug Seroquel are sometimes added until it subsides.

I ended up giving up on Geodon when it appeared the amplified side effects were not going away, so I tried switching to Seroquel which turned out to be the right move.

If It Doesn't Work: You will probably need to try a different antipsychotic drug. Risperidone and Zyprexa are possibilities. Clozapine is another choice.

If anything happens to you what with the drug beginning to stop working and stuff like it did to me, I highly recommend switching to a different antipsychotic all together. I made the transition from Geodon to Seroquel, and it was a very smooth transition.

If It Does Work: The question of how long people with schizophrenia should stay on an antipsychotic medication has never been answered completely. Most say that after a first episode, it may be possible to try to stop the medication after six months to a year, but the risk of developing another psychotic episode is great. Because ziprasidone is well tolerated and seems to have a very low risk for weight gain or tardive dyskinesia, most doctors recommend that their patients with schizophrenia who respond to the medication stay on it for an indefinite period of time. For bipolar patients with mania, it is usually tapered and discontinued after the patient is calm and can be managed with mood stabilizers like lithium, Depakote, or Lamictal alone.

The funny thing about Geodon for me was that at the beginning of treatment with it, it worked GREAT!! Better than any other antipsychotic. If it would have never stopped working I'd likely still be on the med. Unfortunately, that wasn't the case though.

Cost: Generic Geodon is not available and hence it is an expensive medication.

Geodon is a fairly new drug so it won't be generic and thus cheap for a long while.

Special Comments: Before approval by the FDA, some research studies suggested that Geodon might have a serious adverse effect on the heart, called QT or QTc prolongation. This can cause sudden death. The FDA held off approval until further tests were done; these revealed that Geodon does not seem to cause this problem to any significant extent. Moreover, it has not been a problem in the thousands of patients who have taken it since it was approved, so clinicians do not consider it a risk. Unfortunately, a competing drug company highlighted the issue even before Geodon was officially approved, scaring away many physicians. Now that the heart issue has been resolved, the major question about Geodon is how well it works. It was a very good side effect profile, so everyone would like it to work, but it does not seem to be as potent, at least until the dose gets to 80 mg twice a day, as either Zyprexa or Risperdal.

Yes, the heart thing is definitely something to pay attention to as I remember feeling like Geodon altered my heart rhythm (which I know sounds real scary), but my EKG test indicated my heart beat was fine so I don't know...I'm not sure what this "Geodon not being as potent" stuff is 'cause like I said, when it worked for me, it kicked symptoms right squa in the groin with authority!! Booyah Grandma!!

This Geodon page was typed on February 16, 2008.
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