Assessment of the relationship between atypical antipsychotic use and glucose abnormalities is complicated by the possibility of an increased background risk of diabetes mellitus in patients with schizophrenia and the increasing incidence of diabetes mellitus in the general population. Over 325 of these subjects participated in trials involving the administration of multiple doses. Ziprasidone should also be avoided in patients with congenital long QT syndrome and in patients with a history of cardiac arrhythmias [see Contraindications (4)]. Antipsychotic treatment itself, however, may suppress (or partially suppress) the signs and symptoms of the syndrome, and thereby may possibly mask the underlying process. Titration within the range of 4080 mg twice daily (in 20 mg twice daily increments) was permitted for the duration of study (beginning on Day 2). In the second phase of the trial, ECGs were obtained at the time of maximum plasma concentration while the drug was co-administered with an inhibitor of the CYP4503A4 metabolism of the drug. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). In clinical trials with oral ziprasidone, the electrocardiograms of 2/2988 (0.06%) patients who received GEODON and 1/440 (0.23%) patients who received placebo revealed QTc intervals exceeding the potentially clinically relevant threshold of 500 msec. While all of the drugs in the class have been shown to produce some metabolic changes, each drug has its own specific risk profile. When meds are run together at a Y site, there is actually very little surface area of mixture between the two. This higher dose group was not superior to placebo on the BPRS psychosis cluster or on the SANS. In a long-term (at least 1 year), placebo-controlled, fixed-dose study in schizophrenia, the mean change from baseline weight for ziprasidone 20 mg BID was -2.6 kg (N=72); for ziprasidone 40 mg BID was -3.3 kg (N=69); for ziprasidone 80 mg BID was -2.8 kg (N=70) and for placebo was -3.8 kg (N=70). Instruct patients to report to their health care provider at the earliest onset any signs or symptoms that may be associated with Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) or with severe cutaneous adverse reactions, such as Stevens-Johnson syndrome [see Warnings and Precautions (5.5)]. Ziprasidone may induce orthostatic hypotension associated with dizziness, tachycardia, and, in some patients, syncope, especially during the initial dose-titration period, probably reflecting its 1-adrenergic antagonist properties. In the trial, ECGs were obtained at the time of maximum plasma concentration following two injections of ziprasidone (20 mg then 30 mg) or haloperidol (7.5 mg then 10 mg) given four hours apart. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Generic name: ziprasidone hydrochloride The safety and effectiveness of Geodon have not been established in pediatric patients. Approximately 20% of the dose is excreted in the urine, with approximately 66% being eliminated in the feces. There was an increase in the number of pups born dead and a decrease in postnatal survival through the first 4 days of lactation among the offspring of female rats treated during gestation and lactation with doses of 10 mg/kg/day (0.5 times the MRHD based on mg/m2 body surface area) or greater. While these symptoms can occur at low doses, they occur more frequently and with greater severity with high potency and at higher doses of first generation antipsychotic drugs. The other patient had a QTc of 391 msec at the end of treatment with ziprasidone and upon switching to thioridazine experienced QTc measurements of 518 and 593 msec. Can you mix geodon and lorazepam in the same syringe? Each study included 2 to 3 fixed doses of ziprasidone as well as placebo. The mean increase in QTc from baseline for haloperidol was 6.0 msec following the first injection and 14.7 msec following the second injection. A syndrome of potentially irreversible, involuntary, dyskinetic movements may develop in patients undergoing treatment with antipsychotic drugs. The efficacy of oral ziprasidone in the treatment of schizophrenia was evaluated in 5 placebo-controlled studies, 4 short-term (4- and 6-week) trials and one maintenance trial. One case of priapism was reported in the premarketing database. In long-term (at least 1 year), placebo-controlled, flexible-dose studies in schizophrenia, the mean change from baseline in random total cholesterol for ziprasidone 2040 mg BID was +2.5 mg/dL (N=14); for ziprasidone 6080 mg BID was -19.7 mg/dL (N=10); and for placebo was -28.0 mg/dL (N=9). Last updated on Mar 1, 2022. Dystonia - Class Effect: Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment. Dopamine Epinephrine (Adrenalin) Esmolol (Brevibloc) Furosemide (Lasix) Heparin Insulin (regular) Lidocaine (Xylocaine) Lorazepam (Ativan) Magnesium . Ziprasidone was shown to increase time to copulation in Sprague-Dawley rats in two fertility and early embryonic development studies at doses of 10 to 160 mg/kg/day (0.5 to 8 times the MRHD of 200 mg/day based on mg/m2 body surface area). Can you. Syncope was reported in 0.6% of the patients treated with ziprasidone. Acute Treatment of Agitation in Schizophrenia. Low serum potassium and magnesium should be replaced before proceeding with treatment. The effects on fertility are reversible [see Warnings and Precautions (5.15) and Use in Specific Populations (8.3)]. Applies to: Ativan (lorazepam) and Zyprexa (olanzapine) Ask your doctor before using LORazepam together with OLANZapine. Package insert / product label Symptoms of schizophrenia include: The developmental no-effect dose is 5 mg/kg/day (0.2 times the MRHD based on mg/m2 body surface area). Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Geodon Injection Dosage and Administration Acute Treatment of Agitation in Schizophrenia Intramuscular Dosing The recommended dose is 10 mg to 20 mg administered as required up to a maximum dose of 40 mg per day. My preferred agitation regimen is the following: 1) Known or suspected psychosis: 5mg Droperidol +/- 5-10 mg Versed, generally IM pending IV access--takes 5-10 min. The two drugs are so compatible that you can mix them together in the same syringe. Titration within the range of 4080 mg twice daily (in 20 mg twice daily increments) was permitted for the duration of the study. Hyperglycemia and diabetes mellitus, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, have been reported in patients treated with atypical antipsychotics. A study directly comparing the QT/QTc prolonging effect of oral ziprasidone with several other drugs effective in the treatment of schizophrenia was conducted in patient volunteers. Contains 10 of NDC 0049-1203-01, Geodon for Injection Ziprasidone is a medication that works in the brain to treat schizophrenia. Can you mix geodon and lorazepam in the same syringe? In male mice, there was no increase in incidence of tumors relative to controls. no its not good to mix any drugs together in a syringe inless its in a IV bag mixed by a professional but deffinitly dont mix in a single syringe. Although fewer patients have been treated with GEODON, it is not known if this more limited experience is the sole reason for the paucity of such reports. There was no evidence to suggest that these developmental effects were secondary to maternal toxicity. It is essential to periodically monitor serum electrolytes in patients for whom diuretic therapy is introduced during ziprasidone treatment. Since no preservative or bacteriostatic agent is present in this product, aseptic technique must be used in preparation of the final solution. GEODON is not approved for the treatment of patients with dementia-related psychosis [see Boxed Warning and Warnings and Precautions (5.1)]. Although torsade de pointes has not been observed in association with the use of ziprasidone in premarketing studies and experience is too limited to rule out an increased risk, there have been rare post-marketing reports (in the presence of multiple confounding factors) [see Adverse Reactions (6.2)]. Although there are no reports of adverse effects on a breastfed infant exposed to ziprasidone via breast milk, there are reports of excess sedation, irritability, poor feeding, and extrapyramidal symptoms (tremors and abnormal muscle movements) in infants exposed to other atypical antipsychotics through breast milk (see Clinical Considerations). This minimal amount of contact and mixing may allow 2 meds that really aren't terribly compatible to be given together because . Other severe cutaneous adverse reactions, such as Stevens-Johnson syndrome, have been reported with ziprasidone exposure. Patients with severe neutropenia (absolute neutrophil count <1000/mm3) should discontinue GEODON and have their WBC followed until recovery. During long-term therapy with ziprasidone, a categorization of patients at baseline on the basis of body mass index (BMI) revealed the greatest mean weight gain and highest incidence of clinically significant weight gain (> 7% of body weight) in patients with low BMI (<23) compared to normal (2327) or overweight patients (>27). Mixing the two could lead to serious side effects such as drowsiness, impaired motor skills, and even respiratory depression. If circumstances are so compelling as to warrant mixing any Although a single fixed-dose haloperidol arm was included as a comparative treatment in one of the three short-term trials, this single study was inadequate to provide a reliable and valid comparison of ziprasidone and haloperidol. Persistently prolonged QTc intervals may also increase the risk of further prolongation and arrhythmia, but it is not clear that routine screening ECG measures are effective in detecting such patients. Medically reviewed by Drugs.com. In a multiple-dose (8 days of treatment) study involving 32 subjects, there was no difference in the pharmacokinetics of ziprasidone between men and women or between elderly (>65 years) and young (18 to 45 years) subjects. Patients with neutropenia should be carefully monitored for fever or other symptoms or signs of infection and treated promptly if such symptoms or signs occur. Advise breastfeeding women using GEODON to monitor infants for excess sedation, irritability, poor feeding, and extrapyramidal symptoms (tremors, and abnormal muscle movements) and to seek medical care if they notice these signs [see Use in Specific Populations (8.2)]. Close medical supervision and monitoring should continue until the patient recovers. 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