side effects, dosage, how to take & discontinue, uses, pros & cons, and more
Geodon Article Index | Brand and Generic Availability ›
Brand & Generic Names; Drug Class
Geodon’s Approved & Off-Label Uses (Indications)
US FDA Approved Treatment(s)
Schizophrenia, monotherapy for short-term bipolar disorder, as an add-on for maintenance of bipolar
Popular Off-Label Uses
Bipolar depression, unipolar depression (with or without an antidepressant), prescribing it to children (Geodon is an adults-only medication), dementia (will they never learn?).
Learn More about Geodon’s Approved & Off-label Uses
How Long Until Geodon Starts Working (Onset of Action)
Like most APs Geodon works quickly. While IM Geodon may not be as fast as IM Zyprexa in an ER setting, if you don’t get noticeable positive benefit within three days it’s time to move on to another AP.
Likelihood of Working
I’ll let you know.
Learn how Geodon Compares with Other Drugs
How to Take Geodon
Always take the capsules with food! This is to help prevent, or at least minimize nausea and other GI problems, and so your body can best absorb the Geodon. Taking it on an empty stomach will make Geodon pass right through you in more ways than one.
I can’t argue with Pfizer’s recommendations. For acute (short-term) treatment:
Geodon Capsules should be administered at an initial daily dose of 20 mg twice daily with food. In some patients, daily dosage may subsequently be adjusted on the basis of individual clinical status up to 80 mg twice daily. Dosage adjustments, if indicated, should generally occur at intervals of not less than 2 days, as steady-state is achieved within 1 to 3 days. In order to ensure use of the lowest effective dose, patients should ordinarily be observed for improvement for several weeks before upward dosage adjustment
Efficacy in schizophrenia was demonstrated in a dose range of 20 mg to 100 mg twice daily in short-term, placebo-controlled clinical trials. There were trends toward dose response within the range of 20 mg to 80 mg twice daily, but results were not consistent. An increase to a dose greater than 80 mg twice daily is not generally recommended. The safety of doses above 100 mg twice daily has not been systematically evaluated in clinical trials. —Geodon PI sheet
So 20 to 80mg a day, twice a day for a total of 40 to 160mg a day, depending on how much you need to be relatively not crazy. The part is the part I like best is their recommendation for long-term (maintenance) treatment: 20mg twice a day. That’s it. More if required, but 40mg a day should do it.
Unlike a lot of APs, Pfizer’s dosage recommendations for bipolar disorder is also flexible. Like most APs it starts out twice as high as that for schizophrenia, and the top end is a lot higher, but at least they’re still flexible on the dosage:
[Geodon] should be administered at an initial daily dose of 40 mg twice daily with food. The dose may then be increased to 60 mg or 80 mg twice daily on the second day of treatment and subsequently adjusted on the basis of tolerance and efficacy within the range 40 mg-80 mg twice daily. In the flexible-dose clinical trials, the mean daily dose administered was approximately 120 mg. —Geodon PI sheet
Learn More about Taking and Discontinuing Geodon
Normally I’d suggest starting out at a low dosage and slowly increasing your dosage (titrating), but due to the way Geodon works, that’s not really a good idea for someone having a manic or mixed episode, or tends to be manic or mixed more often than depressed. If you’re taking it for bipolar depression, then starting low and increasing slowly is the way to go.
How to Stop Taking Geodon (Discontinue, Withdrawal)
Good question! Pfizer doesn’t provide a discontinuation schedule, and Geodon’s PK is complicated. It also does some serotonin and norepinephrine reuptake inhibition and is also a partial serotonin agonist, so it’s not surprising that SSRI/SNRI-discontinuation-like symptoms have been reported with Geodon in addition to the very rare supersensitivity psychosis. On the other hand, it acts the most like an SNRI at the lower dosages. Right now I don’t know which is better, slowly like an SNRI, or quickly like the 2–3 day titration minimum.
Geodon’s Pros and Cons
- Geodon is less likely to mess with your blood sugar (insulin resistance) and cholesterol than any other antipsychotic.
- Like Abilify, Geodon rarely causes weight gain.
- The lowest dosage (20mg twice a day) is the recommended maintenance dosage of Geodon for schizophrenia.
- If you or any in your immediately family is suspected of having heart problems not related to being overweight and/or having high cholesterol - which is usually some form of cardiac arrhythmia - any good doctor will either not prescribe Geodon or will have you get a full cardiac workout before you take it, before you increase your dosage, and on a regular basis afterwards.
- Weight gain or increased insulin resistance may be rare with Geodon, but high blood pressure isn’t. Which is weird with APs.
- A low dosage and slow titration doesn’t really work if you’re bipolar and are manic or mixed when you start taking Geodon.
Interesting Stuff your Doctor Probably didn’t Tell You about Geodon
At low dosages Geodon is like taking an SNRI like Pristiq or Cymbalta along with an antipsychotic (AP). As its SNRI effect is less than its action as an AP, Geodon’s use as an antidepressant, by itself or as an add on, is probably more noticeable at a lower dosage. Sort of like Lamictal, only for reasons that are easy to understand.
Best Known for
Sending the bipolar on a one-way trip to Manic Town, especially if they’re taking an antidepressant.
In-Depth Pros & Cons
Don’t worry about buying one. Windows shop and share the designs you’d like to buy. Do you have something better to do right now?
Geodon’s Potential Side Effects (Adverse Reactions)
Typical Side Effects
The usual for antipsychotics: being really tired, dizzy and light-headed, having weird dreams, headaches, dry mouth, nausea, constipation and assorted other GI problems, and various movement disorders like tics, twitches, EPS and akathisia. All of which should become bearable and/or go away within a week or two. If you get EPS or akathisia you’ll have to stop taking Geodon. Geodon can also make you anxious, which is something APs are used to treat.
Uncommon Side Effects
Geodon kind of messes with your immune system the way some antiepileptic drugs do. You can become more prone to respiratory and skin infections and even get a scary rash that, while usually not bad as Lamictal’s, can get bad enough to require treatment with steroids, or even force you to stop taking Geodon. Like all APs, your blood pressure can become so low you’ll pass out if you stand up too quickly (orthostatic hypotension). Unlike most APs Geodon can cause high blood pressure, which compounds the heart arrhythmia. Geodon also messes with your vision in a variety of ways.
Freaky Rare Side Effects
Lingual dystonia. Spontaneous orgasm. Not all side effects are necessarily bad thing. This is also a freaky rare side effect of Clopixol (zuclopentixol), Stelazine (trifluoperazine), and Navane (thiothixene). One more reason for me to love antipsychotics.
Learn More about Geodon’s Side Effects.
TMI at times
What You Really Need to be Careful About
Increased mortality rate when used to treat old people with psychosis. Just like every other AP that is overly- and often improperly-used for that purpose.
Be extra careful with Geodon if you have the slightest hint of a heart arrhythmia.
Geodon’s Black Box and Other Warnings, Pregnancy Category, etc.
ziprasidone’s Half-Life & How Long Until It Clears Your System
Plasma half-life: Oral Geodon (ziprasidone HCl) has a half-life of 7 hours. As Geodon is transformed into four metabolites, I need to get back to you on how long it takes to clear.
ziprasidone’s Pharmacokinetics Information Overload
Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream, so there’s nothing swimming around to attach itself to your brain and start doing stuff1. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what2, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood. If we’ve found the complete clearance, or how to calculate it if it requires things like your weight and what your piss looks like, you’ll find that on ziprasidone’s pharmacokinetics page.
How ziprasidone Works
the current best guess at any rate
Geodon is a broad-spectrum atypical/second-generation antipsychotic. It is similar to Seroquel in how it works, but without the antihistamine and antimuscarinic action that causes weight gain. In addition to being a D2 antagonist like practically every AP on the planet, Geodon also binds to D3 receptors. Like most AAPs Geodon also binds to the α1 adrenergic receptor. Like Seroquel, Abilify, and Clozaril (clozapine), Geodon is a partial agonist at serotonin 5-HT1A receptors. Like many AAPs Geodon also binds to the serotonin 5-HT2A, 5-HT2C, and 5-HT7. Unlike practically every crazy med on the planet that affects it, Geodon is a 5-HT1D antagonist, whereas triptans and similar drugs that abort migraines are usually 5-HT1D agonists.
In English: Like most APs Geodon discourages (is an antagonist) the reception of the popular neurotransmitters dopamine, norepinephrine, and serotonin at those receptors. It also regulates (usually by enhancing) the reception of serotonin at the 5-HT1A receptor, which is responsible for its antidepressant effect. Geodon is also a moderate serotonin and norepinephrine reuptake inhibitor (SNRI) like Pristiq and Cymbalta. Because it is both a mild reuptake inhibitor and potent antagonist of NE, Geodon can make you more or less anxious when you start taking it, then do the exact opposite at a higher dosage.
Learn More than You Probably Ever Wanted to Know about How ziprasidone Works
AKA mechanism/method of action, pharmacodynamics
Ratings, Reviews, Comments, PI Sheet, and More
Popular because it is unlikely to cause weight gain or diabetes, but scarey because it may give you a heart attack - in reality only increase the chances a little more than most doctors are rightly, or should be, comfortable with if you were susceptible to having one in the first place - Geodon is essentially the Lamictal of antipsychotics. Like Lamictal Geodon acts more like an antidepressant at lower dosages, and it messes with your skin. And while Geodon carries the same generally low risk of sexual side effects that most APs have, it can also have a positive effect in that department. Like Depakote for in-patient use, I don’t have a better idea than Pfizer’s rapid titration if you’re experiencing bad mania or a bad mixed state. I don’t know if that’s the best thing to do, I just don’t know if there’s a better way to use Geodon, or if, like Lamictal, it’s better to get stable on another med first, and then switch to Geodon for maintenance.
Mouse’s experience with Geodon was weird. It’s doubtful you, or anyone else will go through anything that comes close to what we did. Shortly after she began taking it her memory became so bad that at one point I had to give her block-by-block directions on how to get home. Not only did she forget how to get to where we lived, she couldn’t remember what I told her in the time it took her to drive one block. It was like instant Alzheimer’s, losing both experiential (where we lived) and true short-term (seven seconds) memory. It got only worse the next day, so Geodon was a very short ride on her med-go-round.
Gaaack! I had to leave the above in to illustrate how fucked-up my memory has become lately. I managed to conflate Mouse’s Geodon experience with that of Gabitril. It was a cocktail of Geodon and Celexa that caused her to max out our credit card in 1, count it - one night.
As if I didn’t go on long enough already.
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Pages and Forum Topics Google Thinks are Relevant to Your Mental Health
It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.
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- Geodon’s Full US Prescribing Information
- Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
Geodon Article Index | Brand and Generic Availability ›
1 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady stage if they can't get, or won't provide a number for that.
2 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.
3 Thank you! I'll be here at least 72 hours. Be sure to tip your content provider. And don't try the veal, it's cruelicious!
4 These include: Canada's Product Monographs (PM), New Zealand's Medicine Data Sheets (MDS), the EU's European Public Assessment Reports (EPAR), and the Summary of Product Characteristics (SPC) used in Britain, Ireland, and many other places.
If you have any questions not answered here, please see the Crazymeds Geodon discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)
|Last modified on Wednesday, 04 May, 2016 at 17:19:15 by JerodPoore||Page Author Jerod Poore||Date created Friday, 28 December 2012 at 12:49:43|
|“Geodon (ziprasidone): a Review for the Educated Consumer.” by Jerod Poore is copyright © 2012 Jerod Poore ||Published online 2012/12/29|
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Geodon, and all other drug names on this page and used throughout the site, are a trademark of someone else. Geodon’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.
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All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
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Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList,
NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
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Crazymeds now uses a secure server, but it is not so secure that you can discuss anything having to do with nuclear power facilities, air traffic control systems, aircraft navigation systems, weapons control systems, or any other system requiring failsafe operation whose failure could lead to injury, death or environmental damage. Just so you know. So if you’re mentally interesting and have a job that deals with that sort of thing, talk about said job elsewhere. Otherwise feel free to discuss your meds and brain cooties.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.
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