Preparation for Child Psych PRITE and Boards
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.
- 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