The recommended dose is 10 mg to 20 mg administered as required up to a maximum dose of 40 mg per day. In the same long-term studies, the proportion of subjects with 7% increase in weight from baseline for ziprasidone 2040 mg BID was 5.6% (N=124); for ziprasidone 6080 mg BID was 20.0% (N=10), and for placebo was 5.6% (N=72). The mechanism of action of ziprasidone in the treatment of the listed indications could be mediated through a combination of dopamine type 2 (D2) and serotonin type 2 (5HT2) antagonism. Applies to: Ativan (lorazepam) and Geodon (ziprasidone) Using LORazepam together with ziprasidone may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Patients with a pre-existing low WBC or a history of drug induced leukopenia/neutropenia should have their complete blood count (CBC) monitored frequently during the first few months of therapy and should discontinue GEODON at the first sign of decline in WBC in the absence of other causative factors. Long-standing hyperprolactinemia when associated with hypogonadism may lead to decreased bone density. Published data from observational studies, birth registries, and case reports on the use of atypical antipsychotics during pregnancy do not report a clear association with antipsychotics and major birth defects. This can cause low blood pressure, shallow breathing, weak pulse, muscle weakness, drowsiness, dizziness and slurred speech. Applies to: Thorazine (chlorpromazine) and Ativan (lorazepam) Using chlorproMAZINE together with LORazepam may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Ziprasidone intramuscular has not been systematically evaluated in elderly patients (65 years and over). Ativan Injection (Lorazepam Injection) may treat, side effects, dosage, drug interactions, warnings, patient labeling, reviews, and related medications including drug comparison and health resources. Absorption: Ziprasidone is well absorbed after oral administration, reaching peak plasma concentrations in 6 to 8 hours. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Esophageal dysmotility and aspiration have been associated with antipsychotic drug use. During clinical trials, seizures occurred in 0.4% of patients treated with ziprasidone. Chronic antipsychotic treatment should generally be reserved for patients who suffer from a chronic illness that (1) is known to respond to antipsychotic drugs, and (2) for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate. Cimetidine at a dose of 800 mg QD for 2 days did not affect ziprasidone pharmacokinetics. A median weight gain of 0.5 kg was observed in ziprasidone patients compared to no median weight change in placebo patients. Upon appearance of rash for which an alternative etiology cannot be identified, ziprasidone should be discontinued. Discontinue ziprasidone if severe cutaneous adverse reactions are suspected. Protect from light. The management of NMS should include: (1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy; (2) intensive symptomatic treatment and medical monitoring; and (3) treatment of any concomitant serious medical problems for which specific treatments are available. There were confounding factors that may have contributed to the occurrence of seizures in many of these cases. The results of the oral ziprasidone trials in adult bipolar I disorder, manic/mixed episode follow: in a 3-week placebo-controlled trial (n=210), the dose of ziprasidone was 40 mg twice daily on Day 1 and 80 mg twice daily on Day 2. Geodon, for example, is rarely give with Ativan in my experience. Cardiovascular monitoring should commence immediately and should include continuous electrocardiographic monitoring to detect possible arrhythmias. The risk of developing tardive dyskinesia and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increase. A half-life of 7.1 hours was observed in subjects with cirrhosis compared to 4.8 hours in the control group. There is no known treatment for established cases of tardive dyskinesia, although the syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn. Dosage form: injection, powder, lyophilized, for solution In addition, instruct patients to report symptoms such as dizziness, palpitations, or syncope to the prescriber [see Warnings and Precautions (5.3)]. 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. 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. Ziprasidone at a dose of 40 mg twice daily administered concomitantly with lithium at a dose of 450 mg twice daily for 7 days did not affect the steady-state level or renal clearance of lithium. All reported reactions are included except those already listed in Table 11 or elsewhere in labeling, those reaction terms that were so general as to be uninformative, reactions reported only once and that did not have a substantial probability of being acutely life-threatening, reactions that are part of the illness being treated or are otherwise common as background reactions, and reactions considered unlikely to be drug-related. Efficacy was evaluated by analysis of the area under the curve (AUC) of the Behavioural Activity Rating Scale (BARS) and Clinical Global Impression (CGI) severity rating. 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. Of the total number of subjects in clinical studies of ziprasidone, 2.4 percent were 65 and over. Of these 5700, over 4800 were patients who participated in multiple-dose effectiveness trials, and their experience corresponded to approximately 1831 patient-years. Tiger26 said: I've actually never used the B-52 during residency. Mixing the two could lead to serious side effects such as drowsiness, impaired motor skills, and even respiratory depression. Since no preservative or bacteriostatic agent is present in this product, aseptic technique must be used in preparation of the final solution. Commonly Observed Adverse Reactions in Short Term-Placebo-Controlled Trials. Advise pregnant women to notify their healthcare provider if they become pregnant or intend to become pregnant during treatment with GEODON. Titration within the range of 4080 mg twice daily (in 20 mg twice daily increments) was permitted for the duration of the study. In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of antidiabetic treatment despite discontinuation of the suspect drug. In the rat study, there was no evidence of an increased incidence of tumors compared to controls. The trial included patients whose most recent episode was manic or mixed, with or without psychotic features. 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. Note that a 30 mg dose of intramuscular ziprasidone is 50% higher than the recommended therapeutic dose. Proliferative changes in the pituitary and mammary glands of rodents have been observed following chronic administration of other antipsychotic agents and are considered to be prolactin-mediated. mixed in the same syringe for use in a syringe driver over 24 hours. They're not even allowed in the same syringe. Ziprasidone (Geodon) agitation may occur; Lorazepam 0.05 mg/kg IV/IM/PO up to 2 mg per dose. As with other drugs that antagonize dopamine D2 receptors, ziprasidone elevates prolactin levels in humans. Geodon and Benadryl drug interactions - a phase IV clinical study of FDA data Summary: Drug interactions are reported among people who take Geodon and Benadryl. 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. Ziprasidone dosed adjunctively to valproate in a maintenance trial of bipolar patients did not affect mean therapeutic valproate levels. This minimal amount of contact and mixing may allow 2 meds that really aren't terribly compatible to be given together because . Healthcare providers are encouraged to register patients by contacting the National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or online at http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry/. These symptoms have varied in severity. Two meds that are Y site compatible may not necessarily be compatible mixed in an IM syringe. If you are taking both of these medications, be sure to use separate syringes for each one. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Mixing solutions of parenteral drugs is generally not recommended because of the potential for incompatibility and consequent loss of activity of one or both drugs. Positive results were obtained in both the in vitro mammalian cell gene mutation assay and the in vitro chromosomal aberration assay in human lymphocytes. 1). Intramuscular administration of ziprasidone for more than three consecutive days has not been studied. Adverse reactions are further categorized by body system and listed in order of decreasing frequency according to the following definitions: Frequent - adverse reactions occurring in at least 1/100 patients (1.0% of patients) (only those not already listed in the tabulated results from placebo-controlled trials appear in this listing); Infrequent - adverse reactions occurring in 1/100 to 1/1000 patients (in 0.11.0% of patients). Division of Pfizer Inc There are no known clinically relevant inhibitors or inducers of aldehyde oxidase. GEODON for Injection (ziprasidone mesylate) should only be administered by intramuscular injection and should not be administered intravenously. For one, we typically use 10, 2, and 50 mg, which is 4 mL and too much for one muscle. The possibility of a suicide attempt is inherent in psychotic illness or bipolar disorder, and close supervision of high-risk patients should accompany drug therapy. In arriving at a diagnosis, it is important to exclude cases where the clinical presentation includes both serious medical illness (e.g., pneumonia, systemic infection, etc.) There is no information on the effects of ziprasidone on milk production. Drug-drug interactions can be pharmacodynamic (combined pharmacologic effects) or pharmacokinetic (alteration of plasma levels). Rare adverse reactions occurring in fewer than 1/1000 patients (<0.1% of patients). Can you mix geodon and lorazepam in the same syringe? Carbamazepine is an inducer of CYP3A4; administration of 200 mg twice daily for 21 days resulted in a decrease of approximately 35% in the AUC of ziprasidone. If you are prescribed both medications, it is important to take them as directed by your healthcare provider. Title: 136192_NDH12 Author: BDTEMP1 Created Date: 1/14/2011 9:39:58 PM . Thus, the potential for drug interactions with ziprasidone due to displacement is minimal. Generally, in the maintenance phase, patients continued on the same dose on which they were stabilized during the stabilization phase. Close medical supervision and monitoring should continue until the patient recovers. 2) Undifferentiated but routine drunk agitation: 5-10 mg Versed, also . Dystonia - Class Effect: Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment. Feb 15, 2021 A grizzled LPN veteran taught me a nice little trick, pull up your haldol first in the syringe and inject it into your Ativan vial, then draw both of them up. Dosed adjunctively to valproate in a maintenance trial of bipolar patients did not affect ziprasidone pharmacokinetics cause low blood,..., patients continued on the same syringe mg QD for 2 days not!: ziprasidone is well absorbed after oral administration, reaching peak plasma in. 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