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Geodon (Ziprasidone Hydrochloride) - Indications and Dosage

 
 



INDICATIONS & USAGE

GEODON is indicated for the treatment of schizophrenia, as monotherapy for the acute treatment of bipolar manic or mixed episodes, and as an adjunct to lithium or valproate for the maintenance treatment of bipolar disorder. GEODON intramuscular is indicated for acute agitation in schizophrenic patients. When deciding among the alternative treatments available for the condition needing treatment, the prescriber should consider the finding of ziprasidone's greater capacity to prolong the QT/QTc interval compared to several other antipsychotic drugs [see Warnings and Precautions ]. Prolongation of the QTc interval is associated in some other drugs with the ability to cause torsade de pointes-type arrhythmia, a potentially fatal polymorphic ventricular tachycardia, and sudden death. In many cases this would lead to the conclusion that other drugs should be tried first. Whether ziprasidone will cause torsade de pointes or increase the rate of sudden death is not yet known [see Warnings and Precautions]

1.1 Schizophrenia

Geodon is indicated for the treatment of schizophrenia. The efficacy of oral ziprasidone was established in four short-term (4- and 6-week) controlled trials of adult schizophrenic inpatients and in one maintenance trial of stable adult schizophrenic inpatients [see Clinical Studies].

1.2 Bipolar I Disorder

    Geodon is indicated as monotherapy for the acute treatment of manic or mixed episodes associated with bipolar I disorder. Efficacy was established in two 3-week monotherapy studies in adult patients. [see Clinical Studies].

Geodon is indicated as an adjunct to lithium or valproate for the maintenance treatment of bipolar I disorder. Efficacy was established in a maintenance trial in adult patients. The efficacy of Geodon as monotherapy for the maintenance treatment of bipolar I disorder has not been systematically evaluated in controlled clinical trials. [see Clinical Studies].

1.3 Acute Agitation in Schizophrenic Patients

GEODON intramuscular is indicated for the treatment of acute agitation in schizophrenic patients for whom treatment with ziprasidone is appropriate and who need intramuscular antipsychotic medication for rapid control of agitation. The efficacy of intramuscular ziprasidone for acute agitation in schizophrenia was established in single day controlled trials of agitated schizophrenic inpatients. [see Clinical Trials]

"Psychomotor agitation" is defined in DSM-IV as "excessive motor activity associated with a feeling of inner tension." Schizophrenic patients experiencing agitation often manifest behaviors that interfere with their diagnosis and care, e.g., threatening behaviors, escalating or urgently distressing behavior, or self-exhausting behavior, leading clinicians to the use of intramuscular antipsychotic medications to achieve immediate control of the agitation.

Since there is no experience regarding the safety of administering ziprasidone intramuscular to schizophrenic patients already taking oral ziprasidone, the practice of co-administration is not recommended.

Ziprasidone intramuscular is intended for intramuscular use only and should not be administered intravenously.

DOSAGE & ADMINISTRATION

2.1 Schizophrenia

Dose Selection

GEODON Capsules should be administered at an initial daily dose of 20 mg twice daily with food. In some patients, daily dosage may subsequently be adjusted on the basis of individual clinical status up to 80 mg twice daily. Dosage adjustments, if indicated, should generally occur at intervals of not less than 2 days, as steady-state is achieved within 1 to 3 days. In order to ensure use of the lowest effective dose, patients should ordinarily be observed for improvement for several weeks before upward dosage adjustment.

Efficacy in schizophrenia was demonstrated in a dose range of 20 mg to 100 mg twice daily in short-term, placebo-controlled clinical trials. There were trends toward dose response within the range of 20 mg to 80 mg twice daily, but results were not consistent. An increase to a dose greater than 80 mg twice daily is not generally recommended. The safety of doses above 100 mg twice daily has not been systematically evaluated in clinical trials [see Clinical Studies].

Maintenance Treatment

While there is no body of evidence available to answer the question of how long a patient treated with ziprasidone should remain on it, a maintenance study in patients who had been symptomatically stable and then randomized to continue ziprasidone or switch to placebo demonstrated a delay in time to relapse for patients receiving Geodon. [see Clinical Studies]. No additional benefit was demonstrated for doses above 20 mg twice daily. Patients should be periodically reassessed to determine the need for maintenance treatment.

2.2 Bipolar I Disorder

    Acute Treatment of Manic or Mixed Episodes

Dose Selection--Oral ziprasidone should be administered at an initial daily dose of 40 mg twice daily with food. The dose may then be increased to 60 mg or 80 mg twice daily on the second day of treatment and subsequently adjusted on the basis of tolerance and efficacy within the range 40 mg–80 mg twice daily. In the flexible-dose clinical trials, the mean daily dose administered was approximately 120 mg [see Clinical Studies].

Maintenance Treatment (as an adjunct to lithium or valproate)

Continue treatment at the same dose on which the patient was initially stabilized, within the range of 40 mg–80 mg twice daily with food. Patients should be periodically reassessed to determine the need for maintenance treatment. [see Clinical Studies]

2.3 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. Doses of 10 mg may be administered every two hours; doses of 20 mg may be administered every four hours up to a maximum of 40 mg/day. Intramuscular administration of ziprasidone for more than three consecutive days has not been studied.

If long-term therapy is indicated, oral ziprasidone hydrochloride capsules should replace the intramuscular administration as soon as possible.

Since there is no experience regarding the safety of administering ziprasidone intramuscular to schizophrenic patients already taking oral ziprasidone, the practice of co-administration is not recommended.

Ziprasidone intramuscular is intended for intramuscular use only and should not be administered intravenously.

Intramuscular Preparation for Administration

GEODON for Injection (ziprasidone mesylate) should only be administered by intramuscular injection and should not be administered intravenously. Single-dose vials require reconstitution prior to administration.

Add 1.2 mL of Sterile Water for Injection to the vial and shake vigorously until all the drug is dissolved. Each mL of reconstituted solution contains 20 mg ziprasidone. To administer a 10 mg dose, draw up 0.5 mL of the reconstituted solution. To administer a 20 mg dose, draw up 1.0 mL of the reconstituted solution. Any unused portion should be discarded. Since no preservative or bacteriostatic agent is present in this product, aseptic technique must be used in preparation of the final solution. This medicinal product must not be mixed with other medicinal products or solvents other than Sterile Water for Injection. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

2.4 Dosing in Special Populations

Oral: Dosage adjustments are generally not required on the basis of age, gender, race, or renal or hepatic impairment. Geodon is not approved for use in children or adolescents.

Intramuscular: Ziprasidone intramuscular has not been systematically evaluated in elderly patients or in patients with hepatic or renal impairment. As the cyclodextrin excipient is cleared by renal filtration, ziprasidone intramuscular should be administered with caution to patients with impaired renal function. Dosing adjustments are not required on the basis of gender or race [see Use in Specific Populations (8) ].

DOSAGE FORMS & STRENGTHS

GEODON Capsules are differentiated by capsule color/size and are imprinted in black ink with "Pfizer" and a unique number. GEODON Capsules are supplied for oral administration in 20 mg (blue/white), 40 mg (blue/blue), 60 mg (white/white), and 80 mg (blue/white) capsules. They are supplied in the following strengths and package configurations:

GEODON Capsules

Capsules Strenght (mg)                                            Imprint

20                                                                            396

40                                                                            397

60                                                                            398

80                                                                             399

 GEODON for Injection is available in a single-dose vial as ziprasidone mesylate (20 mg ziprasidone/mL when reconstituted according to label instructions) [see Dosage and Administration]. Each mL of ziprasidone mesylate for injection (when reconstituted) affords a colorless to pale pink solution that contains 20 mg of ziprasidone and 4.7 mg of methanesulfonic acid solubilized by 294 mg of sulfobutylether β-cyclodextrin sodium (SBECD).

HOW SUPPLIED

GEODON Capsules are differentiated by capsule color/size and are imprinted in black ink with "Pfizer" and a unique number. GEODON Capsules are supplied for oral administration in 20 mg (blue/white), 40 mg (blue/blue), 60 mg (white/white), and 80 mg (blue/white) capsules. They are supplied in the following strengths and package configurations:

Package Configuration            Capsule Strenght (mg)             NDC Code                                   Imprint

Bottles of 60                                       20                         NDC-0049-3960-60                               396

Bottles of 60                                       40                         NDC-0049 -3970-60                                397                             

Bottles of 60                                       60                         NDC-0049-3980-60                                 398

Bottles of 60                                       80                          NDC-0049-3990-60                                399                

Unit dose/80                                        20                         NDC-0049-3960-41                                 396

Unit dose/80                                        40                          NDC-0049-3970-41                                397

Unit dose/80                                        60                          NDC-0049-3980-41                                398

Unit dose/80                                        80                          NDC-0049-3990-41                                399



GEODON Capsules should be stored at 25°C (77°F); excursions permitted to 15–30°C (59–86°F) [See USP Controlled Room Temperature].

PATIENT COUNSELING INFORMATION

See FDA-Approved Patient Labeling .

Please refer to the patient package insert. To assure safe and effective use of GEODON, the information and instructions provided in the patient information should be discussed with patients.

17.1 Administration with Food

Patients should be instructed to take GEODON Capsules with food for optimal absorption. The absorption of ziprasidone is increased up to two-fold in the presence of food [see Drug Interactions and Clinical Pharmacology].

17.2 QTc Prolongation

Patients should be advised to inform their health care providers of the following: History of QT prolongation; recent acute myocardial infarction; uncompensated heart failure; prescription of other drugs that have demonstrated QT prolongation; risk for significant electrolyte abnormalities; and history of cardiac arrhythmia [see Contraindications and Warnings and Precautions].

Patients should be instructed to report the onset of any conditions that put them at risk for significant electrolyte disturbances, hypokalemia in particular, including but not limited to the initiation of diuretic therapy or prolonged diarrhea. In addition, patients should be instructed to report symptoms such as dizziness, palpitations, or syncope to the prescriber [see Warnings and Precautions].

17.3 FDA-Approved Patient Labeling

PATIENT SUMMARY OF INFORMATION ABOUT
GEODON® Capsules
(ziprasidone HCl)

Information for patients taking GEODON or their caregivers

This summary contains important information about GEODON. It is not meant to take the place of your doctor's instructions. Read this information carefully before you take GEODON. Ask your doctor or pharmacist if you do not understand any of this information or if you want to know more about GEODON.

What Is GEODON?

GEODON is a type of prescription medicine called a psychotropic, also known as an atypical antipsychotic. GEODON can be used to treat symptoms of schizophrenia and acute manic or mixed episodes associated with bipolar disorder. GEODON can also be used as maintenance treatment of bipolar disorder when added to lithium or valproate.

Who Should Take GEODON?

Only your doctor can know if GEODON is right for you. GEODON may be prescribed for you if you have schizophrenia or bipolar disorder.

Symptoms of schizophrenia may include:

  • hearing voices, seeing things, or sensing things that are not there (hallucinations)
  • beliefs that are not true (delusions)
  • unusual suspiciousness (paranoia)
  • becoming withdrawn from family and friends

Symptoms of manic or mixed episodes of bipolar disorder may include:

  • extremely high or irritable mood
  • increased energy, activity, and restlessness
  • racing thoughts or talking very fast
  • easily distracted
  • little need for sleep

If you show a response to GEODON, your symptoms may improve. If you continue to take GEODON there is less chance of your symptoms returning. Do not stop taking the capsules even when you feel better without first discussing it with your doctor.

It is also important to remember that GEODON capsules should be taken with food.

What is the most important safety information I should know about GEODON?

GEODON is not approved for the treatment of patients with dementia-related psychosis. Elderly patients with a diagnosis of psychosis related to dementia treated with antipsychotics are at an increased risk of death when compared to patients who are treated with placebo (a sugar pill).

GEODON is an effective drug to treat the symptoms of schizophrenia and the manic or mixed episodes of bipolar disorder. However, one potential side effect is that it may change the way the electrical current in your heart works more than some other drugs. The change is small and it is not known whether this will be harmful, but some other drugs that cause this kind of change have in rare cases caused dangerous heart rhythm abnormalities. Because of this, GEODON should be used only after your doctor has considered this risk for GEODON against the risks and benefits of other medications available for treating schizophrenia or bipolar manic and mixed episodes.

Your risk of dangerous changes in heart rhythm can be increased if you are taking certain other medicines and if you already have certain abnormal heart conditions. Therefore, it is important to tell your doctor about any other medicines that you take, including non-prescription medicines, supplements, and herbal medicines. You must also tell your doctor about any heart problems you have or have had.

Who should NOT take GEODON?

Elderly patients with a diagnosis of psychosis related to dementia. GEODON is not approved for the treatment of these patients.

Anything that can increase the chance of a heart rhythm abnormality should be avoided. Therefore, do not take GEODON if:

  • You have certain heart diseases, for example, long QT syndrome, a recent heart attack, severe heart failure, or certain irregularities of heart rhythm (discuss the specifics with your doctor)
  • You are currently taking medications that should not be taken in combination with ziprasidone, for example, dofetilide, sotalol, quinidine, other Class Ia and III anti-arrhythmics, mesoridazine, thioridazine, chlorpromazine, droperidol, pimozide, sparfloxacin, gatifloxacin, moxifloxacin, halofantrine, mefloquine, pentamidine, arsenic trioxide, levomethadyl acetate, dolasetron mesylate, probucol or tacrolimus.

What To Tell Your Doctor Before You Start GEODON

Only your doctor can decide if GEODON is right for you. Before you start GEODON, be sure to tell your doctor if you:

  • have had any problem with the way your heart beats or any heart related illness or disease
  • any family history of heart disease, including recent heart attack
  • have had any problem with fainting or dizziness
  • are taking or have recently taken any prescription medicines
  • are taking any over-the-counter medicines you can buy without a prescription, including natural/herbal remedies
  • have had any problems with your liver
  • are pregnant, might be pregnant, or plan to get pregnant
  • are breast feeding
  • are allergic to any medicines
  • have ever had an allergic reaction to ziprasidone or any of the other ingredients of GEODON capsules. Ask your doctor or pharmacist for a list of these ingredients
  • have low levels of potassium or magnesium in your blood

Your doctor may want you to get additional laboratory tests to see if GEODON is an appropriate treatment for you.

GEODON And Other Medicines

There are some medications that may be unsafe to use when taking GEODON, and there are some medicines that can affect how well GEODON works. While you are on GEODON, check with your doctor before starting any new prescription or over-the-counter medications, including natural/herbal remedies.

How To Take GEODON

  • Take GEODON only as directed by your doctor.
  • Swallow the capsules whole.
  • Take GEODON capsules with food.
  • It is best to take GEODON at the same time each day.
  • GEODON may take a few weeks to work. It is important to be patient.
  • Do not change your dose or stop taking your medicine without your doctor's approval.
  • Remember to keep taking your capsules, even when you feel better.

Possible Side Effects

Because these problems could mean you're having a heart rhythm abnormality, contact your doctor IMMEDIATELY if you:

  • Faint or lose consciousness
  • Feel a change in the way that your heart beats (palpitations)

Common side effects of GEODON include the following and should also be discussed with your doctor if they occur:

  • Feeling unusually tired or sleepy
  • Nausea or upset stomach
  • Constipation
  • Dizziness
  • Restlessness
  • Abnormal muscle movements, including tremor, shuffling, and uncontrolled involuntary movements
  • Diarrhea
  • Rash
  • Increased cough / runny nose

If you develop any side effects that concern you, talk with your doctor. It is particularly important to tell your doctor if you have diarrhea, vomiting, or another illness that can cause you to lose fluids. Your doctor may want to check your blood to make sure that you have the right amount of important salts after such illnesses.

For a list of all side effects that have been reported, ask your doctor or pharmacist for the GEODON Professional Package Insert.

What To Do For An Overdose

In case of an overdose, call your doctor or poison control center right away or go to the nearest emergency room.

Other Important Safety Information

A serious condition called neuroleptic malignant syndrome (NMS) can occur with all antipsychotic medications including GEODON. Signs of NMS include very high fever, rigid muscles, shaking, confusion, sweating, or increased heart rate and blood pressure. NMS is a rare but serious side effect that could be fatal. Therefore, tell your doctor if you experience any of these signs.

Adverse reactions related to high blood sugar (hyperglycemia), sometimes serious, have been reported in patients treated with atypical antipsychotics. There have been few reports of hyperglycemia or diabetes in patients treated with GEODON, and it is not known if GEODON is associated with these reactions. Patients treated with an atypical antipsychotic should be monitored for symptoms of hyperglycemia.

Dizziness caused by a drop in your blood pressure may occur with GEODON, especially when you first start taking this medication or when the dose is increased. If this happens, be careful not to stand up too quickly, and talk to your doctor about the problem.

Before taking GEODON, tell your doctor if you are pregnant or plan on becoming pregnant. It is advised that you don't breast feed an infant if you are taking GEODON.

Because GEODON can cause sleepiness, be careful when operating machinery or driving a motor vehicle.

Since medications of the same drug class as GEODON may interfere with the ability of the body to adjust to heat, it is best to avoid situations involving high temperature or humidity.

It is best to avoid consuming alcoholic beverages while taking GEODON.

Call your doctor immediately if you take more than the amount of GEODON prescribed by your doctor.

GEODON has not been shown to be safe or effective in the treatment of children and teenagers under the age of 18 years old.

Keep GEODON and all medicines out of the reach of children.

How To Store GEODON

Store GEODON capsules at room temperature (59°–86°F or 15°–30°C).

For More Information About GEODON

This sheet is only a summary. GEODON is a prescription medicine and only your doctor can decide if it is right for you. If you have any questions or want more information about GEODON, talk with your doctor or pharmacist. You can also visit www.geodon.com.

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