Posted by SLS on September 30, 2012, at 3:18:11
In reply to Re: I'm done with benzos. What else can I use?, posted by jono_in_adelaide on September 30, 2012, at 0:31:13
Hi Jono.
I am surprised by the study you provided. Geodon (ziprasidone) is somewhat weird. At low dosages, Geodon blocks 5-HT2c receptors to a greater extent than the 5-HT2a or DA receptors, and is an inhibitor of NET and SERT. It is described as being be activating, and even agitating at low dosages by Stephen Stahl. He explains the pharmacology underlying the clinical observation, and he recommends using higher dosages. In my opinion, Geodon is just an unpredictable drug. I guess there is nothing to lose by trying it, though. For all I know, Stahl is completely wrong. There is the possibility, though, that his observations are limited to people suffering from schizophrenia, and that they do not extrapolate well to other disorders. Interestingly, it is the blockade of 5-HT2c receptors by Prozac that might explain why some people experience anxiety and agitation when they first begin taking that drug.
http://www.medscape.org/viewarticle/484929
"Here's a very interesting thing about ziprasidone. Have you ever given ziprasidone at 20 mg and had a patient become activated and agitated? If you have, the reason is that the dosing is too low. Because this is such a powerful 5HT2C antagonist, at low doses, that's all it does. It doesn't have any dopamine antagonism, so it's potentially activating, at least for those people whose genes don't want to have their 5HT2C receptors blocked...
To prevent this, you've got to do a counterintuitive thing, which is to stop using 20 mg, because you're going to make patients "go bonkers." You've got to use probably 60 mg to have enough robust D2 on board so that the patient doesn't get activated. This is an art. Some patients tolerate different doses than others; but the counterintuitive thing is that you raise the dose, you get less activation. If you've had bad experience with this particular drug, that might help you understand how to dose"
I was impressed with Phenergan (promethazine) for anxiety. I've seen it work well enough such that it was an effective replacement for Zyprexa in a male schizophrenic, but without the metabolic side effects.
Agitation is listed as a frequent side effect of Geodon in the package label.
http://www.rxlist.com/geodon-drug/side-effects-interactions.htm
- Scott> "I can't see Geodon as being used as a PRN for anxiety, especially when lower dosages can be anxiogenic and produce insomnia. Is it worth a try? I guess so."
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> http://www.ncbi.nlm.nih.gov/pubmed/11910268
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> The novel atypical antipsychotic ziprasidone has a pharmacologic profile notable for potent agonism of serotonin (5-HT)1A receptors, antagonism at 5-HT1D receptors, and reuptake inhibition of norepinephrine. 5-HT1A receptor agonism, in particular, suggests anxiolytic activity, and ziprasidone has shown preliminary efficacy in treating the symptoms of anxiety associated with psychotic disorders. In this study, the anxiolytic efficacy of ziprasidone was evaluated in nonpsychotic subjects who were anxious before undergoing minor dental surgery. We compared a single oral dose of 20 mg ziprasidone (N = 30) with that of 10 mg diazepam (N = 30) and placebo (N = 30) in a randomized, parallel-group, double-blind study. The peak anxiolytic effect of ziprasidone compared with that of placebo was similar to that of diazepam but had a later onset. At 3 hours postdose, the anxiolytic effect of ziprasidone was significantly greater than that of placebo (p < 0.05) and somewhat greater than that of diazepam. Diazepam showed a significantly greater anxiolytic effect than placebo at 1 hour (p < 0.05) but not at 3 hours. The sedative effect of ziprasidone was never greater than that of placebo, whereas that of diazepam was significantly greater than that of placebo 1 to 1.5 hours postdose. Ziprasidone was generally well tolerated. Only one patient reported treatment-related adverse events (nausea and vomiting) and, unlike diazepam, ziprasidone did not cause reductions in blood pressure. Dystonia, extrapyramidal syndrome, akathisia, and postural hypotension were not seen with ziprasidone. Thus, ziprasidone may possess anxiolytic effects in addition to its antipsychotic properties.
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> I would definatly try Atarax first ( the drowsiness passes off within a week) but if you have failed both atarax and benzos, then I would think a theraputic trial of Geodon in a low dose would be indicated
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1027041
URL: http://www.dr-bob.org/babble/20120922/msgs/1027086.html