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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by chloe on July 10, 2001, at 9:17:14
This med is very new, and was hoping to hear so personal experiences with it. Any successes? What are the main side effects? Activating or sedating?
My pdoc wants me to have an EKG first. I am more than annoyed. I am very fit and healthy with no history of heart disease in my family. So before I go and have expensive diagnostic tests, etc. I was hoping for some insight on this new(expensive)med.
Many thanks,
Chloe
Posted by kid_A on July 10, 2001, at 9:29:24
In reply to GEODON, any stories, info please, posted by chloe on July 10, 2001, at 9:17:14
chloe,
I've been taking Geodon for the past 3-4 weeks or so, and I can say for one, that I haven't noticed any side effects from it whatsoever... As for the benefits, it's difficult to say since I am taking two other AD's right now allong w/ Geodon, but I am noticing that the dark cloud that is my normal thought process is starting to lift...As for the EKG... that might be a tad bit cautious, unless your family has a history of heart problems... But it is due to the fact that geodon shouldnt be perscribed to people who allready do have qt-syndrom as geodon was shown to prolong the qt interval....
How much mg a day are you taking?
Here's an interesting link that explains qt:
Posted by SalArmy4me on July 10, 2001, at 13:16:21
In reply to GEODON, any stories, info please, posted by chloe on July 10, 2001, at 9:17:14
I took Geodon for a month for unipolar depression. I had no side-effects except for a little sedation. I took up to 160 mg of it in divided doses 3 times a day. Once, I took too much of it and got a dystonic reaction that was only remedied by Benadryl.
It didn't work for my depression, but then again, nothing does. All these tests are really unnecessary unless you really have a serious heart problem. http://www.medsafe.govt.nz/Profs/datasheet/z/zeldoxcap.htm
Posted by Zo on July 10, 2001, at 15:03:57
In reply to GEODON, any stories, info please, posted by chloe on July 10, 2001, at 9:17:14
> This med is very new, and was hoping to hear so personal experiences with it. Any successes? What are the main side effects? Activating or sedating?
We were looking for a replacement for Xyprexa - Geodon was released specifically to compete with Zyprexa, because it has not been shown to cause the weight gain - but I found it to be nothing but sedating. Zyprexa might be worth a try - it's covered by insurance, and not everyone has the weight gain. And there's also Risperidol, which I've just started, and several other atypical APs; I don't know why Geodon would be anyone's first choice, considering the expense.
Good luck,
Zo
Posted by chloe on July 10, 2001, at 16:38:15
In reply to Re: GEODON, any stories, info please » chloe, posted by Zo on July 10, 2001, at 15:03:57
I don't know why Geodon would be anyone's first choice, considering the expense.
>
>
>Hi Zo
It's not the first choice. I have tried all of the atypicals. I get tongue movements from Seroquel, galactorrea (milk from my breasts!) and too much activation from Rispiridol, and I feel hostile and aggressive on Zyprexa.
I really don't have much hope for Geodon either.But my doc thinks it worth a try, since I had such success and stability for years on typical AP's in the past. Nothing seems to touch the ruminating thoughts and distorted thinking like an AP. When they work, they really work well!
And Kid_A, I don't have any heart problems, but an overcautious doc. I can't start the med until I have the EKG. Grrr. But thanks for the link.
Sorry it didn't help your depression, Sal
Thanks for the help.
Chloe
Posted by Sunnely on July 10, 2001, at 20:28:58
In reply to GEODON, any stories, info please, posted by chloe on July 10, 2001, at 9:17:14
Pre-treatment and maintenance EKG is not required with Geodon therapy. The FDA reserves this test at doctors' clinical discretion based on each patient's health or medical status. However, because Geodon can prolong QTc, there are people who should not be prescribed Geodon or should have some tests done prior to or during Geodon therapy.
It should be noted that, relative to haloperidol (Haldol), all of the atypical antipsychotics cause some degree of QTc prolongation. Within the class of the first-line antipsychotics, Geodon has a higher numerical average QTc prolongation than the others, ranging from 9 to 14 milliseconds (msec). In understanding whether this "numerical" difference is important, it is helpful to contrast this QTc prolongation with that seen with other psychiatric medications and to know the likelihood of serious drug-drug interactions occurring, such as were seen with terfenadine (Seldane).
The QTc on EKG is a measure of the time needed for depolarization and repolarization of the heart ventricles. The longer the QTc, the longer the time required. Slight increases in QTc are common. However, large prolongations of QTc are a marker for increased risk of ventricular arrhythmias. A specific arrhythmia known as torsades de pointes is associated with long QTc and sudden death. Most cardiologists feel that a QTc reading of >500 milliseconds puts the person at a high risk for this of arrhythmia.
Many other psychiatric medications prolong the QTc interval much more than any of the atypical antipsychotics. These include thioridazine (Mellaril), pimozide (Orap), and droperidol (Inapsine) and the tricyclic antidepressants (TCAs). Note that all of these medications were previously considered to be reasonably safe at therapeutic doses, but that they can be dangerous in overdose situations.
In contrast to the heart problems seen with overdoses of TCA, it seems that Geodon is very safe in overdose situations. So far, no heart problems have arisen from overdose, with the highest recorded overdose, I believe being 3240 mg. Of note, there were no abnormalities on the EKG during heart monitoring of this case.
People who should not be prescribed Geodon include the following:
1. Recent heart attack
2. Uncompensated congestive heart failure
3. History of cardiac arrhythmia (irregular heart beat), heart block, bradycardia (markedly slow heart rate)
4. Have congenital long QT syndrome
5. Myocarditis
6. Idiopathic cardiomyopathy
7. Mitral valve prolapse
8. Taking drugs that prolong QTc (see list below)
People who have history of palpitations, lightheadedness, fainting spells, and rapid heart beat, should have an EKG done prior to Geodon therapy. If EKG shows prolongation of QTc, they should not be prescribed Geodon.
People with the following condition(s) should have at least an EKG, blood potassium and magnesium levels drawn prior to treatment of Geodon. If EKG shows prolong QTc, should not be prescribed Geodon. If EKG is normal but potassium and magnesium levels are low (hypokalemia and hypomagnesemia, respectively), supplement and correct the deficiency in potassium and magnesium before starting Geodon.
1. History of eating disorders
2. Actively dehydrated, vomiting, diarrhea
3. Taking diuretics
4. History of alcohol abuse or dependence
While on Geodon therapy:
1. Notify your doctor immediately if you experience rapid heart beat, lightheadedness, palpitations, vomiting or diarrhea, or other illness that can cause loss of fluids.
2. Avoid excessive use of alcohol.
3. Notify your physician before taking any prescription, over-the-counter drugs, or herbal preparations.
Drugs that can prolong QTc:
Psychotropic drugs: chlorpromazine (Thorazine), thioridazine (Mellaril), mesoridazine (Serentil), pimozide (Orap), haloperidol (Haldol) I.V., droperidol (Inapsine), tricyclic antidepressants (TCAs).
Antibiotic drugs: clarithromycin (Biaxin), erythromycin (E.E.S., Erythrocin), gatifloxacin (Tequin), grepafloxacin (Raxar), levofloxacin (Levaquin), moxifloxacin (Avelox), sparfloxacin (Zagam), quinupristin/dalfopristin (Synercid I.V.)
Anti-arrhythmic drugs: amiodarone (Cordarone), disopyramide (Norpace), dofetilide (Tikosyn), flecainide (Tambocor), ibutilide (Corvert), moricizine (Ethmozine), procainamide (Procan, Pronestyl), quinidine (Cardioquin, Quinidex, Quinaglute), sotalol (Betapace), tocainide (Tonocard).
Others: arsenic trioxice (Trisenox) for treatment of leukemia; astemizole (Hismanal) - off the market; bepridil (Vascor) - anti-angina; cisparide (Propulsid) - off the market; felbamate (Felbatrol) - anticonvulsant; fludrocortisone (Florinef) - may cause congestive heart failure and low potassium; foscarnet (Foscavir) - for HIV infection; fosphenytoin (Cerebryx) - anticonvulsant; halofantrine (Halfan) - for malaria infection; indapamide (Lozol) - can cause low potassium; isradipine (Dynacirc) - for high blood pressure; ipecac - stimulates vomiting; levomethadyl (Orlaam) - opiate agonist; naratriptan (Amerge) and sumatriptan (Imitrex) - for migraine; nicardipine (Cardene) - for high blood pressure; pentamidine (Pentam) - for penumocystis pneumonia; probucol (Lorelco) - for high cholesterol; tacrolimus (Prograf) - immune suppressant; tamoxifen (Nolvadex) - for breast cancer; terfenadine (Seldane) - off the market; tizanidine (Zanaflex) - muscle relaxant.
BTW, QTc interval is longer in women than men. Consuming a large meal can increase the QTc as well.
If you don't have any family or personal history of heart disease, no history of palpitations, lightheadedness or fainting episodes, not actively dehydrated, vomiting or have diarrhea, not actively alcoholic, not taking diuretics, or other drugs that can prolong QTc, I see no reason to do an EKG prior to Geodon therapy.
During clinical trials, sedation appears to be a common complaint. However, in the real world of prescribing, there seems to be an equal proportions of patients reporting either sedation or insomnia.
Actually, compared to the other atypical antipsychotics, Geodon is probably the least costly. The reason for this is, Pfizer decided to price each tablet of Geodon (20 mg, 40 mg, 60 mg, and 80 mg) the same. The cost of a 20-mg tablet is the same as that of an 80-mg tablet. Therefore, no increase in cost even with an increase in dose. This is strictly a business strategy.
Finally, Geodon is a first-line antipsychotic drug and not an alternative treatment. Also, make sure you take Geodon with food (e.g., with breakfast and supper; snacks, sandwich, even milk is OK). Geodon works better with food.
For more info on prolong QTC and Torsades, visit the following websites:
http://georgetowncert.org/qtdrugs.html
::::::::::::::::::::::::::::::::::
> This med is very new, and was hoping to hear so personal experiences with it. Any successes? What are the main side effects? Activating or sedating?
>
> My pdoc wants me to have an EKG first. I am more than annoyed. I am very fit and healthy with no history of heart disease in my family. So before I go and have expensive diagnostic tests, etc. I was hoping for some insight on this new(expensive)med.
>
> Many thanks,
> Chloe
Posted by SalArmy4me on July 10, 2001, at 21:30:34
In reply to Re: GEODON, any stories, info please » chloe, posted by Sunnely on July 10, 2001, at 20:28:58
> Actually, compared to the other atypical antipsychotics, Geodon is probably the least costly. The reason for this is, Pfizer decided to price each tablet of Geodon (20 mg, 40 mg, 60 mg, and 80 mg) the same. The cost of a 20-mg tablet is the same as that of an 80-mg tablet. Therefore, no increase in cost even with an increase in dose. This is strictly a business >strategy.
100 of the 40 mg tablets costs $440 WHOLESALE. Just imagine what that would cost retail at a Sav-on or something.
Posted by chloe on July 10, 2001, at 21:57:08
In reply to Re: GEODON, any stories, info please » chloe, posted by Sunnely on July 10, 2001, at 20:28:58
Snip > During clinical trials, sedation appears to be a common complaint. However, in the real world of prescribing, there seems to be an equal proportions of patients reporting either sedation or insomnia.<
>Has anyone out there experienced insomnia (anxiety or akethesia, for that matter) with Geodon?
Many thanks all,
C
Posted by ChrisK on July 11, 2001, at 5:02:52
In reply to GEODON, any stories, info please, posted by chloe on July 10, 2001, at 9:17:14
I switched from Zyprexa to Geodon a few months ago and haven't noticed any big changes. For the first month or so my sleep was a little more disturbed but that seems to have subsided. Thankfully I have not had a return of the ruminating thoughts that put me on Zyprexa in the first place.
Since I had been on Zyprexa for a long time my pdoc was able to get me a rider from my insutrance co. to cover the Geodon as well. It is expensive but if you have had some success in the past with atypicals I would say that Geodon is definitely worth a try.
Posted by judy1 on July 11, 2001, at 11:03:09
In reply to Re: GEODON, any stories, info please, posted by chloe on July 10, 2001, at 21:57:08
I'm presently taking zyprexa, which has really been helpful, but of course the weight gain (on top of being pregnant) is very discouraging for me. So I was glad to see this thread. The best AP I ever took was Mellaril- which turned out to have even worse cardiac problems than Geodon, so I had to be taken off of that. Risperdal caused akathisia and tremor, so off of that too. Seroquel simply doesn't work. So, other than everyone thinking I'm about to deliver any moment it looks like I'm stuck with Zyprexa. Thanks for all the info -judy
Posted by Greg on July 12, 2001, at 11:45:52
In reply to GEODON, any stories, info please, posted by chloe on July 10, 2001, at 9:17:14
Chloe,
At a recent Psych's appt I asked him about Geodon. It was just out of curiousity as I've very satisfied with Zyprexa. His comments to me were that it seemed to be a very good med, especially since it has little or no accompanying weight gain which is infamous with the Zy. But, and there's always one of those right? He said there have been some undocumented cases of sudden death among some Geodon users. He said that it appears to be happening predominantly among older patients and those who suffer from cardio-vascular problems. This may be why your doc is hesitant to prescribe it to you until he has run some tests. He said because of that, until some conclusive evidence is documented, either pro or con on Geodon, he won't prescribe it to either his older patients or ones with heart problems.
Remember that this is all undocumented info. If I get any more info on the subject I'll be sure to pass it along. I think the EKG is a good call on your doc's part. Better safe than sorry.
Good luck,
Greg> This med is very new, and was hoping to hear so personal experiences with it. Any successes? What are the main side effects? Activating or sedating?
>
> My pdoc wants me to have an EKG first. I am more than annoyed. I am very fit and healthy with no history of heart disease in my family. So before I go and have expensive diagnostic tests, etc. I was hoping for some insight on this new(expensive)med.
>
> Many thanks,
> Chloe
Posted by chloe on July 13, 2001, at 19:27:37
In reply to Re: GEODON, any stories, info please, posted by Greg on July 12, 2001, at 11:45:52
Well, after all that, the EKG and stuff (normal!), my pdoc told me to take half a pill to start.
How the hell do I cut a capsule in half (to get 10 mgs)? I called her office. Gone for the weekend. I called the pharmacy. They "do not recommend" dissolving it in water and taking half. Is this med water soluble and stable in water?
You all have been so informative and helpful. And I thank all of you. But can you help me out on this one?
Gratefully,
Chloe
Posted by Craig on July 14, 2001, at 1:43:09
In reply to Re: Got the GEODON, now what do I do?, posted by chloe on July 13, 2001, at 19:27:37
You can get the powder out of the capsule by gently twisting and pulling it apart. When I had to do this, I emptied the powder onto a piece of paper. Use a razor blade to separate the powder into two equal piles. Slide one of the piles of powder onto a second sheet of paper. Dump the power into your hand and lick it off!
=================================================
> Well, after all that, the EKG and stuff (normal!), my pdoc told me to take half a pill to start.
>
> How the hell do I cut a capsule in half (to get 10 mgs)? I called her office. Gone for the weekend. I called the pharmacy. They "do not recommend" dissolving it in water and taking half. Is this med water soluble and stable in water?
>
> You all have been so informative and helpful. And I thank all of you. But can you help me out on this one?
>
> Gratefully,
> Chloe
Posted by Jeroen on July 10, 2005, at 15:12:09
In reply to GEODON, any stories, info please, posted by chloe on July 10, 2001, at 9:17:14
hi, i took it 3 weeks lowest dosage and got TD eye blinking from it
be aware!!
This is the end of the thread.
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