Geodon

Schizophrenia

Geodon is primarily prescribed to treat schizophrenia in adults. It helps manage symptoms such as hearing voices or seeing things that are not there (hallucinations), having false beliefs (delusions), and experiencing unusual suspiciousness or social withdrawal.

Bipolar Disorder

This medication is used to treat symptoms of bipolar I disorder, including:

• Acute Manic or Mixed Episodes: It is used to treat sudden episodes of mania, which may involve an abnormally high or irritable mood, racing thoughts, and decreased need for sleep.
• Maintenance Treatment: It may be used as an add-on therapy with other medications, such as lithium or valproate, to help prevent future episodes of bipolar disorder.

Acute Agitation

An injectable form of this medication is sometimes used in clinical settings to quickly control agitation in adults with schizophrenia when rapid treatment is necessary.

Mechanism of Action

Geodon belongs to a class of medications called atypical antipsychotics. While the exact way it works in the brain is not fully understood, it is believed to help manage symptoms by affecting the activity of certain natural substances called neurotransmitters.

Neurotransmitters are chemical messengers that allow nerve cells to communicate. Geodon primarily influences two key chemicals:

• Dopamine: The medication blocks specific dopamine receptors. High levels of dopamine activity in certain parts of the brain are associated with symptoms like hallucinations and disorganized thinking.
• Serotonin: Geodon interacts with several types of serotonin receptors. Serotonin is involved in regulating mood, sleep, and perception.

By balancing the effects of these chemicals, Geodon helps reduce the intensity of symptoms related to schizophrenia and bipolar disorder. It also has a mild effect on the reuptake of other chemicals, such as norepinephrine, which may further assist in stabilizing mood and behavior.

Common Side Effects

Many people using Geodon experience mild side effects. These often include:

• Drowsiness or extreme tiredness
• Dizziness or lightheadedness
• Nausea, vomiting, or stomach pain
• Constipation or diarrhea
• Dry mouth
• Restlessness or an inability to sit still
• Muscle aches or pains
• Cough or runny nose

Serious Side Effects

Some side effects can be severe and require immediate medical care. Contact a healthcare provider right away if you experience:

• Heart rhythm changes: Fast, slow, or irregular heartbeat, or feeling like your heart is racing or fluttering.
• Severe skin reactions: A widespread rash with fever and swollen lymph nodes, known as DRESS syndrome.
• Movement disorders: Uncontrolled movements of the face, tongue, or limbs, which may become permanent.
• Neuroleptic Malignant Syndrome (NMS): High fever, stiff muscles, confusion, sweating, or changes in pulse and blood pressure.
• High blood sugar: Increased thirst, frequent urination, extreme hunger, or fruity-smelling breath.
• Fainting or seizures: Loss of consciousness or sudden convulsions.
• Difficulty swallowing: Trouble moving food or liquid through the throat.
• Prolactin changes: Breast swelling or discharge, or changes in menstrual periods.

Boxed Warning: Dementia-Related Psychosis

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Geodon is not approved for the treatment of patients with dementia-related psychosis.

Heart Rhythm Changes

Geodon can cause a change in the heart's electrical rhythm known as QT prolongation. This condition can lead to a life-threatening heart rhythm disorder. This medication is generally avoided in individuals with a history of certain heart conditions, such as a recent heart attack, heart failure, or specific heart rhythm abnormalities. It is also typically avoided in combination with other medications known to prolong the QT interval.

Severe Skin Reactions

A rare but serious condition called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) has been reported with this medication. This reaction may start as a rash but can progress to affect internal organs such as the liver, kidneys, or lungs. Immediate medical attention is necessary if a rash occurs along with a fever or swollen lymph nodes.

Neuroleptic Malignant Syndrome (NMS)

NMS is a rare and potentially fatal condition associated with antipsychotic medication. Symptoms may include high fever, muscle stiffness, confusion, and changes in pulse or blood pressure.

Tardive Dyskinesia

Use of Geodon may lead to tardive dyskinesia, a condition characterized by involuntary, repetitive body movements, often involving the face, tongue, or jaw. The risk may increase with long-term use.

Metabolic Changes

Antipsychotic medications can cause metabolic changes, including:

• High blood sugar: Increases in blood glucose levels, which can lead to diabetes.
• Cholesterol changes: Increases in cholesterol and triglyceride levels in the blood.
• Weight gain: Significant weight gain has been observed in some patients.

Additional Precautions

• Orthostatic Hypotension: A drop in blood pressure when standing up, which may cause dizziness or fainting.
• Blood Cell Counts: Potential for a decrease in white blood cell counts, such as leukopenia or neutropenia.
• Seizures: An increased risk of seizures, particularly in those with a history of seizure disorders.
• Body Temperature: Impaired ability to reduce body temperature, which may lead to overheating during strenuous exercise or extreme heat.

Pregnancy

Ziprasidone should only be used during pregnancy if the potential benefit to the patient justifies the potential risk to the fetus. Taking antipsychotic medications like ziprasidone during the third trimester of pregnancy may cause complications in the newborn after delivery. These issues may include:

• Withdrawal symptoms
• Breathing difficulties
• Feeding problems
• Tremors
• Muscle stiffness or floppiness
• Excessive sleepiness

If you become pregnant while taking this medication, do not stop taking it without consulting your healthcare provider, as untreated mental health conditions can also pose risks during pregnancy. There is a pregnancy registry that monitors the health of individuals and their babies who are exposed to atypical antipsychotics during pregnancy. Healthcare providers can provide more information on how to enroll.

Breastfeeding

It is not known for certain if ziprasidone passes into human breast milk or how it might affect a nursing infant. Because many drugs are excreted in human milk, caution is advised. Individuals who are breastfeeding or planning to breastfeed should discuss the potential risks and benefits with their healthcare provider to determine the best course of action for their situation.

Available Forms

Geodon is provided in two primary delivery methods:

• Oral Capsules: These are taken by mouth. It is important to take this form of the medication with food to ensure proper absorption by the body.
• Intramuscular Injection: This form is supplied as a powder that must be reconstituted by a healthcare professional. It is administered as an injection into a muscle, typically for short-term use in acute situations.

FDA Approval and Indications

Geodon (ziprasidone) received its initial FDA approval in 2001. It is currently approved for the treatment of schizophrenia and for the acute treatment of manic or mixed episodes associated with bipolar I disorder. It is also indicated for the maintenance treatment of bipolar I disorder when used alongside lithium or valproate.

Boxed Warning

Geodon carries a boxed warning, the FDA's most serious type of warning, stating that elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Geodon is not approved for the treatment of dementia-related psychosis.

Safety Communications

The FDA has issued safety communications regarding a rare but serious skin reaction known as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). This condition may begin as a rash but can progress to affect internal organs and requires immediate medical attention if symptoms occur.

Availability

Geodon is a prescription-only medication available in oral capsule form and as an intramuscular injection for the acute treatment of agitation in adults with schizophrenia.

Importance of Medical Supervision

You should not stop taking Geodon without first talking to your doctor. Stopping the medication abruptly can cause the symptoms of your condition to return. To prevent this, healthcare providers typically recommend a gradual reduction in dosage rather than stopping the medication all at once.

The Tapering Process

When it is time to discontinue Geodon, your doctor will likely create a tapering schedule. This involves slowly lowering the dose over a period of time to allow your body to adjust. During this process, it is important to:

• Follow the specific schedule provided by your healthcare professional exactly.
• Report any new or returning symptoms to your doctor immediately.
• Keep all follow-up appointments so your progress can be monitored.

If you miss doses or stop the medication entirely without guidance, you may experience a relapse of the condition being treated, such as schizophrenia or bipolar disorder. Even if you feel better, you should continue taking the medication as prescribed until your doctor advises otherwise.