With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. Over the past couple weeks, we covered three commonly used atypical antipsychotics – Zyprexa (olanzapine), Risperdal (risperidone), and Seroquel (quetiapine). Because the Zyprexa post contains a great deal of information that applies to the atypical antipsychotics as a group, we encourage you to read it first.

Like Zyprexa and the other atypical antipsychotics, Geodon (ziprasidone) was developed primarily to treat schizophrenia and psychosis but is approved to treat acute bipolar mania. It does not have FDA approval for maintenance treatment or treatment of bipolar depressive episodes at this time. Geodon can improve symptoms of schizophrenia and psychotic breaks that may occur in bipolar, including the following:

• Hallucinations (audio and visual)
• Delusions
• Disorganized thinking
• Paranoia

It may also improve conditions such as social isolation, limited motivation, and reduced speech activity for some people.

Geodon can also improve symptoms related specifically to mania, including the following:

• Irritability
• Elevated mood
• Impulsivity
• Racing thoughts
• Inflated self esteem
• Decreased need for sleep

Geodon is well established as a treatment to reduce manic episodes but, there is less data regarding its ability to reduce the frequency of cycling in bipolar disorder. Most bipolar specialists believe that it will ultimately be shown that Geodon, like all the other medications in this category, does a reasonable job as a maintenance medication in bipolar disorder. It is also unclear whether Geodon has specific antidepressant qualities, such as those found in Seroquel (quetiapine).

Geodon is unique among this class of medications because it does not have the same risks of weight gain or changes in glucose and lipid metabolism that accompany all of the other medications in this class. When it was released initially by the manufacturer, there was a lot of concern about a potential effect on cardiac rhythms. Most of the drugs in this class carry some similar risks, but it was thought that Geodon might have a higher risk than the others. However, after a number of years in clinical use, this has not turned out to be the case. A doctor will typically order an EKG (heart rhythm test) before prescribing Geodon, because of these concerns.

Typical Dose

Most patients take Geodon two times each day. For bipolar disorder, your prescriber is likely to start you on a low dose, such as 20 mg twice a day, and then increase your dose by every few days or weeks to maximum doses of 80 or 100 mg twice a day. (If you have low blood pressure, poor liver function, or are elderly or in a weakened condition, your prescriber may ramp up the dose even more slowly.) The maximum dose listed by the manufacturer is 80 mg twice per day, but prescribers may use more sometimes depending on the clinical situation. As always, follow your prescriber’s advice and instructions.

In my practice, Geodon is often a second or third choice medication if there has been poor response to other atypicals – or if weight gain or glucose or lipid problems are significant. If a patient is at high risk of diabetes or already has diabetes or poor lipid profiles (high cholesterol, for example) Geodon might be a first choice. There are few studies with Geodon in children and teens, so I use it less frequently in those populations. Many people find Geodon to be a well tolerated medication, without the weight gain problems, although it can be pretty sedating, especially at first.

Geodon is generally not used in individuals with pre-existing cardiac rhythm abnormalities or significant heart disease. There are also a number of other medications, including over-the-counter (OTC) and some natural or herbal products that can cause similar changes in the heart’s electrical circuits, so the doctor must carefully review all of a patient’s other medications and over-the-counter products before prescribing Geodon. The prescriber should also be clear with a patient on Geodon that they must let her know before starting any new medications or over-the-counter products.

Potential Side Effects

Like other atypical antipsychotics, Geodon has the potential of producing negative side effects, including the following:

• Geodon is one of the more sedating of the atypicals – fatigue and dizziness are not uncommon when someone first takes Geodon.
• Movement problems like Parkinson’s disease are rare with Geodon but can occur.
• Irreversible uncontrolled movements called tardive dyskinesia – facial twitches or uncontrolled movements of the tongue, lips, arms, or other body parts (lower risk than older medications). The risk of tardive dyskinesia from Geodon is thought to be low, but long-term data are still evolving, as the medicine is used for more years.
• Changes in cardiac rhythms – specifically elongation of the QT interval on electrocardiogram This can be dangerous and can also interact with a number of other non-psychiatric medications that have similar risks.

Unlike most other atypical antipsychotics, Geodon does not increase levels of the reproductive hormone Prolactin. Many other atypical agents do increase this hormone, which can affect menstrual cycles.

For more about Geodon, visit Pfizer’s Geodon page.

If you’ve taken any form of Geodon for bipolar disorder or are a doctor who has prescribed it, please share your experiences, insights, and observations.

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    Last reviewed: 19 Dec 2008