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
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> 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
poster:Sunnely
thread:69583
URL: http://www.dr-bob.org/babble/20010708/msgs/69654.html