Preparation for Child Psych PRITE and Boards
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Geodon in children

  • Ziprasidone has a greater propensity for QTc prolongation than other atypicals' careful history of congenital long QTc syndrome and heart disease is very important.
  • Weight gain, prolactin elevation and EPS are not as significant as with some of the other atypical antipsychotics.
  • Geodon has no FDA indication for use in children and adolescents, but is widely used off-label (often as second-line medication) for PDD-associated symtpoms, mood disorders, DBDs, eating disorders, OCD, MR, and thought disorders.

High-yield facts

  • PO Geodon should be taken with food: GI absorption is significantly lower in the fasting state
  • Geodon is liver-metabolized by aldehyde oxidase (about two-thirds); CYP 3A4 enzymes play a secondary role (about a third), and thus carabamezapine can decrease and ketoconazole can increase blood levels of Geodon.
  • Just like other 2nd-gen antipsychotics, Geodon has a black-box warning for increased mortality in elderly with dementia.

Black belt facts

  • The absorption of Geodon is increased two-fold in the presence of food (from ~30% to 60%).
    • At least 500kcal is necessary to ensure therapeutic concentration at predictable (dose-dependent) levels.
    • common advice to take Geodon with a snack is misleading: an apple is 100 Cal, granolar bar is about 150.
    • Fat content of the food is not important.
  • Increasing the PO dose does not compensate for lower absorption when on an empty stomach.
    • i.e.doubling the evening dose when one has to skip dinner is not a working strategy


Thombre AG. Improved Ziprasidone Formulations with Enhanced Bioavailability in the Fasted State and a Reduced Food Effect. Pharm Res 2011