Schizophrenia, both short-term and maintenance treatment.
Bipolar disorder, manic and mixed episodes.
IM version approved for treatment of acute agitation in patients with schizophrenia.
D2 and 5HT 2 receptor antagonist.
Supplied in 20 mg, 40 mg, 60 mg, and 80 mg capsules (not breakable). Also available for acute agitation as an injectable in 20 mg/ml single-dose vials.
Start at 20 mg BID with food for 2-3 days, then increase to 80 mg BID. Can usually increase rather quickly to 60 mg or 80 mg BID.
Can probably go higher than the recommended daily maximum of 160 mg; there is good safety data for doses up to 320 mg/day.
BLACK BOX WARNING: All atypicals may increase mortality in elderly patients by 1.7 times greater than placebo.
Most common are somnolence, dizziness, and akathisia. Treat akathisia with inderal 20 mg BID or nadolol 20-40 mg QD.
EPS: Low risk, but possible, especially at higher doses.
Weight gain: Very little, about 1 pound in short-term trials.
Glucose, lipids: Minimal to no effect.
EKG: Average increase in QTc greater than any other atypical although not much more than for Seroquel. Post-marketing surveillance has shown one or two instance of torsade possibly related to Geodon use.
Prolactin level: No effect.
Pregnancy Category C.
The following drugs are contraindicated in combination with Geodon because they all cause QT widening: Psychiatric drugs: thioridazine (Mellaril), chlorpromazine (Thorazine), mesoridazine (Serentil), pimozide (Orap), droperidal. Others: arsenic trioxide, dofetilidine, dolasetron mesylate, gatifloxacin, halofantrine, levomethadyl acetate, mefloquine, moxifloxacin, pentamidine, probucol, quinidine, sotalol, sparfloxacin, and tacrolimus.
Short half-life of 7 hours, leading to manufacturer’s recommendation of BID dosing, but in practice QD dosing is as effective.