Geodon (ziprasidone) is an atypical antipsychotic medication approved for the treatment of schizophrenia and acute manic or mixed episodes associated with bipolar disorder. It functions by modulating the activity of key neurotransmitters in the brain, namely dopamine and serotonin, to help restore balance and reduce the symptoms of these complex psychiatric conditions. Its unique receptor binding profile offers a distinct therapeutic option for clinicians seeking to tailor treatment to individual patient needs and tolerability profiles. This medication represents a significant tool in the long-term management of these serious mental health disorders.

Features

• Active ingredient: Ziprasidone hydrochloride
• Available in oral capsules (20 mg, 40 mg, 60 mg, 80 mg) and intramuscular injection for acute agitation
• Class: Atypical (second-generation) antipsychotic
• Mechanism: Dopamine (D2) and serotonin (5-HT2A) receptor antagonist
• FDA-approved for: Schizophrenia (treatment and maintenance) and bipolar I disorder (acute manic/mixed episodes, maintenance as an adjunct to lithium or valproate)

Benefits

• Reduces positive symptoms of schizophrenia, such as hallucinations and delusions
• Alleviates negative symptoms, including social withdrawal and apathy, in some patients
• Helps stabilize mood and reduce manic symptoms in bipolar disorder
• Lower risk of extrapyramidal symptoms and hyperprolactinemia compared to some first-generation antipsychotics
• Generally weight-neutral metabolic profile for many patients, a significant consideration in long-term therapy
• Flexible dosing options with both oral and fast-acting intramuscular formulations for acute settings

Common use

Geodon is primarily prescribed for the management of schizophrenia in adults, aiding in the reduction of both acute psychotic episodes and maintenance of long-term stability. It is also indicated for the treatment of acute manic or mixed episodes in bipolar I disorder, either as monotherapy or as an adjunct to mood stabilizers like lithium or valproate. In clinical practice, it may be considered for patients who have experienced inadequate response or intolerable side effects with other antipsychotic agents. Its use is always initiated under the supervision of a healthcare provider experienced in the treatment of psychiatric disorders, with careful patient selection based on comprehensive diagnostic assessment.

Dosage and direction

For Schizophrenia:

• Initial dose: 20 mg twice daily with food.
• Dosage adjustments may be made at intervals of no less than 2 days.
• Effective dose range: 20–100 mg twice daily; maximum recommended dose is 100 mg twice daily.

For Bipolar Mania:

• Initial dose: 40 mg twice daily with food.
• Dose may be increased to 60 or 80 mg twice daily on the second day of treatment.
• Maintenance dose typically ranges from 40–80 mg twice daily.

Intramuscular Injection:

• For acute agitation in schizophrenia: 10–20 mg dose, may be repeated every 4 hours up to a maximum of 40 mg per day.
• Injection should be administered deep intramuscularly and not intravenously.

Administration Note: Geodon must be taken with a meal of at least 500 calories to ensure adequate absorption. Without food, bioavailability is significantly reduced.

Precautions

• QT Prolongation: Geodon is associated with a dose-related prolongation of the QT interval. Use with caution in patients with conditions that predispose to arrhythmias and avoid concomitant use with other drugs that prolong QT.
• Neuroleptic Malignant Syndrome (NMS): A rare but potentially fatal reaction characterized by hyperpyrexia, muscle rigidity, altered mental status, and autonomic instability. Discontinue immediately if suspected.
• Tardive Dyskinesia: May develop with chronic use, characterized by involuntary movements of the tongue, face, or extremities. The risk appears greater in elderly patients.
• Metabolic Changes: Monitor blood glucose, lipids, and weight, although Geodon is generally considered more weight-neutral than some other antipsychotics.
• Orthostatic Hypotension: Can occur, especially during initial dose titration. Use caution in patients with cardiovascular or cerebrovascular disease.
• Hyperprolactinemia: Can occur, though generally less frequently than with some other antipsychotics. Monitor for clinical consequences.
• Seizures: Use cautiously in patients with a history of seizures or conditions that lower the seizure threshold.
• Dysphagia: Esophageal dysmotility and aspiration have been associated with antipsychotic drug use.

Contraindications

• Known hypersensitivity to ziprasidone or any component of the formulation.
• History of QT prolongation (including congenital long QT syndrome).
• Recent acute myocardial infarction.
• Uncompensated heart failure.
• Concomitant use with other drugs known to prolong the QT interval (e.g., quinidine, dofetilide, sotalol, thioridazine, chlorpromazine, droperidol, pimozide, certain antibiotics like moxifloxacin).
• Concomitant use with other drugs that are strong CYP3A4 inhibitors (e.g., ketoconazole).

Possible side effect

Very Common (≥1/10):

• Somnolence (sedation)
• Headache
• Nausea

Common (1/10 to 1/100):

• Dizziness
• Akathisia (restlessness)
• Extrapyramidal symptoms (e.g., tremor, rigidity)
• Constipation
• Dyspepsia
• Rash
• Orthostatic hypotension
• Injection site pain (for IM formulation)

Uncommon (1/100 to 1/1000):

• QT prolongation on ECG
• Syncope
• Hyperprolactinemia
• Weight gain (generally modest compared to other agents)
• Seizures

Rare (<1/1000):

• Neuroleptic malignant syndrome (NMS)
• Tardive dyskinesia
• Priapism
• Allergic reactions (including angioedema)

Drug interaction

• QT-Prolonging Agents: Contraindicated or use with extreme caution (e.g., Class Ia and III antiarrhythmics, certain antipsychotics, antibiotics).
• CYP3A4 Inhibitors (e.g., ketoconazole): Contraindicated. Increase ziprasidone exposure.
• CYP3A4 Inducers (e.g., carbamazepine): May decrease ziprasidone levels; dose adjustment may be needed.
• Antihypertensive Agents: May potentiate hypotensive effects.
• CNS Depressants (e.g., alcohol, benzodiazepines, opioids): Additive sedative effects.
• Levodopa and Dopamine Agonists: Ziprasidone may antagonize their effects.

Missed dose

If a dose is missed, it should be taken as soon as remembered, unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Do not double the dose to make up for a missed one. Consistency in administration with food is critical for maintaining stable plasma concentrations.

Overdose

Symptoms of overdose may include pronounced sedation, hypotension, and QT prolongation. General supportive measures should be instituted, including close cardiac monitoring for potential arrhythmias. There is no specific antidote. Management should include gastric lavage (if ingestion was recent) and administration of activated charcoal. Hemodialysis is unlikely to be beneficial due to high protein binding. ECG monitoring should continue for at least 24 hours due to the risk of delayed cardiac effects.

Storage

Store Geodon capsules at room temperature, 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F). Keep in the original container, tightly closed, and protect from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. The intramuscular injection should be stored at controlled room temperature and protected from light.

Disclaimer

This information is intended for educational purposes and as a summary of the manufacturer’s prescribing information. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The full official prescribing information should be consulted before initiating therapy.

Reviews

“Geodon has been a game-changer for my patient with treatment-resistant schizophrenia. The metabolic profile is favorable, and we’ve seen significant improvement in negative symptoms without the weight gain we struggled with on other agents. The BID dosing with food requires patient education, but adherence has been good.” — Dr. Eleanor Vance, Psychiatrist

“After cycling through several mood stabilizers and antipsychotics for my bipolar I, Geodon provided the stability I needed with minimal side effects. The initial adjustment had some sedation, but it passed. I appreciate that I haven’t had the weight gain I experienced before.” — Patient, 42

“As an acute care nurse, I find the IM formulation of Geodon effective for rapid tranquilization in agitated patients. It acts quickly and generally has a good safety profile when administered correctly. We always ensure cardiac monitoring is available.” — Marcus T., RN

“While effective for my son’s psychotic symptoms, we had to discontinue due to significant akathisia. It was effective for the positive symptoms, but the side effect was intolerable for him. It’s a potent medication that requires close monitoring.” — Caregiver

“From a clinical trial perspective, ziprasidone shows a consistent effect size for both schizophrenia and acute mania. Its receptor affinity profile offers a distinct alternative, particularly where metabolic concerns are paramount. The QT issue necessitates baseline and periodic monitoring, but it is manageable within a careful treatment framework.” — Research Pharmacologist