Geodon (ziprasidone) is an atypical antipsychotic medication engineered to provide robust symptom control in schizophrenia and bipolar disorder. It functions by modulating dopamine and serotonin activity, offering a favorable balance between therapeutic effectiveness and tolerability. Clinicians value its proven track record in acute and maintenance therapy, supported by extensive clinical data. This agent is available in both oral capsule and intramuscular injection formulations, allowing for flexible treatment approaches across care settings.

Features

• Active ingredient: Ziprasidone hydrochloride
• Available formulations: Oral capsules (20 mg, 40 mg, 60 mg, 80 mg) and intramuscular injection (20 mg/mL after reconstitution)
• Mechanism: Dopamine D2 and serotonin 5-HT2A receptor antagonist
• Half-life: Approximately 7 hours (oral); peak plasma concentration reached within 6–8 hours
• Metabolism: Primarily hepatic via aldehyde oxidase and CYP3A4
• Excretion: Predominantly fecal (≈66%) with minor renal elimination (≈20%)
• FDA-approved indications: Schizophrenia (acute and maintenance), acute manic or mixed episodes of bipolar I disorder, and maintenance treatment of bipolar disorder as an adjunct to lithium or valproate

Benefits

• Rapid reduction of positive and negative symptoms in schizophrenia, including hallucinations, delusions, and social withdrawal
• Effective management of acute manic/mixed episodes in bipolar I disorder, often within days of initiation
• Lower risk of weight gain and metabolic disturbances compared to some other atypical antipsychotics
• Flexible dosing and formulation options support individualized treatment plans
• Demonstrated efficacy in long-term maintenance therapy, reducing relapse rates
• Generally well-tolerated profile with a lower incidence of extrapyramidal symptoms at therapeutic doses

Common use

Geodon is primarily prescribed for the treatment of schizophrenia in adults, addressing both acute exacerbations and long-term maintenance. It is also indicated for bipolar I disorder, including acute manic or mixed episodes and maintenance therapy in combination with mood stabilizers such as lithium or valproate. Off-label uses may include adjunctive treatment in major depressive disorder and agitation associated with dementia, though evidence is more limited for these applications. Treatment is typically initiated under clinical supervision, with dosage adjustments based on symptom response and tolerability.

Dosage and direction

For schizophrenia:

• Initial dose: 20 mg twice daily with food
• May increase to 60 mg or 80 mg twice daily based on response and tolerability
• Maximum recommended dose: 80 mg twice daily

For acute manic/mixed episodes of bipolar I disorder:

• Day 1: 40 mg twice daily with food
• Day 2: 60 mg or 80 mg twice daily
• Subsequent adjustments based on clinical response; maximum 80 mg twice daily

Intramuscular formulation (for acute agitation in schizophrenia):

• 10 mg to 20 mg doses, may be repeated every 4–6 hours up to a maximum of 40 mg per day

Administration with food (at least 500 calories) is essential to enhance bioavailability. Dosage adjustments are necessary in patients with hepatic impairment or those taking potent CYP3A4 inhibitors.

Precautions

• Regular monitoring of ECG is advised due to dose-related QTc prolongation
• Weight, blood glucose, and lipid levels should be tracked periodically
• Use with caution in patients with cardiovascular disease, cerebrovascular conditions, or seizures
• May impair cognitive or motor skills; advise against driving or operating machinery until response is known
• Esophageal dysmotility and aspiration have been reported with antipsychotic use
• Neuroleptic Malignant Syndrome (NMS) is a rare but serious risk; discontinue immediately if suspected
• Tardive dyskinesia may develop with long-term use; periodic assessments recommended

Contraindications

• Known hypersensitivity to ziprasidone or any component of the formulation
• History of QT prolongation or congenital long QT syndrome
• Recent acute myocardial infarction or uncompensated heart failure
• Concomitant use with other drugs known to prolong QT interval (e.g., quinidine, sotalol, thioridazine)
• Severe hepatic impairment

Possible side effect

Common (≥5%):

• Somnolence (14%)
• Respiratory tract infection (8%)
• Extrapyramidal symptoms (5–8%)
• Dizziness (8%)
• Nausea (10%)
• Constipation (8%)

Less common:

• Orthostatic hypotension (2–5%)
• Akathisia (2–8%)
• Rash (4%)
• Weight gain (2–4%)
• QTc prolongation (dose-dependent)

Rare but serious:

• Neuroleptic malignant syndrome
• Tardive dyskinesia
• Seizures
• Venous thromboembolism
• Hyperglycemia and diabetes mellitus
• Priapism

Drug interaction

• Contraindicated: QT-prolonging agents (e.g., class IA/III antiarrhythmics, certain antibiotics)
• Potent CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): May increase ziprasidone levels; do not exceed 20 mg twice daily
• CYP3A4 inducers (e.g., carbamazepine, rifampin): May decrease ziprasidone efficacy
• Antihypertensives: Enhanced hypotensive effects
• CNS depressants (alcohol, benzodiazepines): Additive sedation
• Levodopa and dopamine agonists: May antagonize effects

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed one. Consistent adherence is important to maintain stable plasma concentrations.

Overdose

Symptoms may include sedation, hypotension, tachycardia, and QTc prolongation. There is no specific antidote. Management includes cardiac monitoring, supportive care, and activated charcoal if ingestion was recent. Hemodialysis is not expected to be effective due to high protein binding.

Storage

Store at controlled room temperature (20–25°C or 68–77°F). Keep in original container, protected from light and moisture. Do not freeze. Keep out of reach of children and pets.

Disclaimer

This information is for educational purposes and does not replace professional medical advice. Always consult a healthcare provider for diagnosis, treatment decisions, and personalized medical guidance. Do not initiate or discontinue Geodon without physician supervision.

Reviews

“Geodon has been transformative for my patients with bipolar disorder who struggled with metabolic side effects on other antipsychotics. The need to take it with food is a minor inconvenience compared to its clinical benefits.” — Dr. Elena Rostova, Psychiatrist

“After switching from olanzapine, I’ve maintained symptom control without the weight gain. The twice-daily dosing is manageable.” — Patient, 34

“While effective, the requirement for ECG monitoring can be a barrier in some outpatient settings. Still, a valuable option in our toolkit.” — Dr. Michael Thorne, Clinical Pharmacologist