![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Bradley on February 23, 2001, at 15:30:13
The studies on Ziprasidone look promising. You have pobably been informed that it should be available in a week or two. Are any of you planning to give it a try.
Allthough it has been approved for schitzophrenia it has AD effects. The side effect profile is less than Zyprexa for example(no weight gain).
Posted by JohnX on February 24, 2001, at 17:28:06
In reply to Ziprasidone, could be a good one, posted by Bradley on February 23, 2001, at 15:30:13
>
> The studies on Ziprasidone look promising. You have pobably been informed that it should be available in a week or two. Are any of you planning to give it a try.
> Allthough it has been approved for schitzophrenia it has AD effects. The side effect profile is less than Zyprexa for example(no weight gain).Bradley,
I hope to give Ziprasidone a try. I haven't
ventured much into the realm of anti-psychotics,
but after reading about this one, I think I'll
give it the green flag. I tend to have really
bad teeth grinding and tension headaches which
are exacerbated by SSRI's (this is somewhat rare).
I also have had hypo-manic responses to
anti-depressants. Serzone had a quality (5-ht2
blockade) which releaved my facial pain, but it
made me incredibly drowsy, which was my main
complaint, and it caused weight gain. The
mechanism that seems to contribute primarily to
the weight gain in Serzone and the
anti-psychotics like zypreza all seem to do with a side effect of the 5ht-2 serotonin receptor blockade which causes noradrenaline
(alpha-1) blockade. This alpha-1 blockade
may cause dizziness and drowsiness too.
Ziprasidone looks like the 1st med that substantially relieves this problem and also adds another feature that will reduce anxiety (5HT-1 agonism). I'm hoping this works well for me.Please keep in touch with anyone's Ziprasidone
experiences.Btw, has anyone tried Serzone and Zyprexa like
meds and found the drowsiness profile to be
similar (..we know they both cause weight gain)?
I'm mainly hoping hoping Ziprasidone won't
affect me cogniztively.-John.
Posted by Cece on March 2, 2001, at 12:58:27
In reply to Re: Ziprasidone, could be a good one, posted by Cece on March 2, 2001, at 12:24:12
> Whoops!
I didn't mean to send a blank post- just wanted to be notified about this thread cuz I'm interested in trying Ziprasidone to see if it might touch what I describe as my "background, chronic demon"- a combo of depressive and anti-anxiety sx which remain despite mood stabilizers, AD's, anti-anxiety meds, and stimulants (all of which have helped much- none of which have really calmed this grinding monster).
How do I get onto thread notification without posting- is it possible?
Cece
Posted by JohnX on March 6, 2001, at 0:45:08
In reply to Re: Ziprasidone, could be a good one, posted by Cece on March 2, 2001, at 12:58:27
> > Whoops!
>
> I didn't mean to send a blank post- just wanted to be notified about this thread cuz I'm interested in trying Ziprasidone to see if it might touch what I describe as my "background, chronic demon"- a combo of depressive and anti-anxiety sx which remain despite mood stabilizers, AD's, anti-anxiety meds, and stimulants (all of which have helped much- none of which have really calmed this grinding monster).
>
> How do I get onto thread notification without posting- is it possible?
>
> Cece
Cece,What is the "grinding monster"?
In my case the grinding monster (no pun intended)
is bruxism (teeth grinding) and chronic tension headaches, as well as anhedonia, bipolar II.What's nice about Ziprasidone is that it has
a secret sauce that Serzone has (5ht-2 antagonism)
+ a secret sauce that Buspar has (5ht-1 agonism)
which should make it a really good anxiety and
anhedonia buster (I hope). It should also cure my
other ailments based on my past experience without inducing mania. The good news is that it appears to be very tolerable wrt side effects. I'm wondering if you could combine Ziprasidone with other anti-depressants?We shall see. It will be very interesting to
see how this one works out. If it works for me
I'll buy some pfizer stock!-JohnX
Posted by Cece on March 7, 2001, at 0:12:03
In reply to Re: Ziprasidone, could be a good one, posted by JohnX on March 6, 2001, at 0:45:08
I'm interested in trying Ziprasidone to see if it might touch what I describe as my "background, chronic demon"- a combo of depressive and anxiety sx which remain despite mood stabilizers, AD's, anti-anxiety meds, and stimulants (all of which have helped much- none of which have really calmed this grinding monster).
> > Cece
>
>
> Cece,
>
> What is the "grinding monster"?
>
> In my case the grinding monster (no pun intended)
> is bruxism (teeth grinding) and chronic tension headaches, as well as anhedonia, bipolar II.John-
Well, I've been trying really hard to put this into words- but it's a slippery 'demon' who lurks, and is hard to pin down.
Part of it is chronic muscle tension, especially in my upper body, and when it's bad my whole chest hurts. Sometimes I call it 'chronic grief'. It's also the constant feeling that something is wrong, that there is something I'm supposed to fix if I could just figure it out. And recurring social withdrawal, a feeling of being assaulted by too much stimulus: light, noise, energy. Oh yeah, and headaches- lots of headaches, like there's not room in my head for everything that's fighting in there.Meds have helped a lot- this all used to be so much worse. But a (dangerous) shadow remains, and I want to chase it down and disarm it. I call it 'grinding' because it is so damn persistent.
Can you relate?
Cece
>
Posted by JohnX on March 7, 2001, at 4:15:55
In reply to Re: Ziprasidone, could be a good one » JohnX, posted by Cece on March 7, 2001, at 0:12:03
> I'm interested in trying Ziprasidone to see if it might touch what I describe as my "background, chronic demon"- a combo of depressive and anxiety sx which remain despite mood stabilizers, AD's, anti-anxiety meds, and stimulants (all of which have helped much- none of which have really calmed this grinding monster).
> > > Cece
> >
> >
> > Cece,
> >
> > What is the "grinding monster"?
> >
> > In my case the grinding monster (no pun intended)
> > is bruxism (teeth grinding) and chronic tension headaches, as well as anhedonia, bipolar II.
>
> John-
>
> Well, I've been trying really hard to put this into words- but it's a slippery 'demon' who lurks, and is hard to pin down.
> Part of it is chronic muscle tension, especially in my upper body, and when it's bad my whole chest hurts. Sometimes I call it 'chronic grief'. It's also the constant feeling that something is wrong, that there is something I'm supposed to fix if I could just figure it out. And recurring social withdrawal, a feeling of being assaulted by too much stimulus: light, noise, energy. Oh yeah, and headaches- lots of headaches, like there's not room in my head for everything that's fighting in there.
>
> Meds have helped a lot- this all used to be so much worse. But a (dangerous) shadow remains, and I want to chase it down and disarm it. I call it 'grinding' because it is so damn persistent.
>
> Can you relate?
>
> Cece
> >Yeah I can relate. We want to finish off our episodes and move on with our lifes, but this monkey just won't get off our backs!
I'm wondering what kind of headaches do you get?
Are they migraine headaches? (Guessing because of
the sensitivity to noise,light,etc).When I get past any major depressive or manic
episodes, I usually normalize into a state of anhedonia (lack of interest or drive) + I always have these lingering tension headaches. My tension headaches go away when I take a stimulant or Klonopin or Serzone. I've nailed it down physiologically to an area of the brain that when hypo-dopaminergic can cause tension, anhedonia, social withdrawl. Meds that block the serotonin
5ht-2 receptor will relieve these symptoms (they will increase dopamine indirectly in the problem spot; stimulants like Adderall increases dopamine directly). The 5ht-2 blocker include Serzone, and
most of the anti-psychotics like Zyprexa. Have you tried Zyprexa? Serzone made me too drowsy, but Ziprasidone is a potent 5ht-2 blocker that seems to not have the Serzone/Zyprexa like side effects.What do you think?
-John
Posted by ChrisK on March 7, 2001, at 5:53:20
In reply to Re: Ziprasidone, could be a good one » Cece, posted by JohnX on March 7, 2001, at 4:15:55
John,
Just jumping into your conversation with Cece but have you considered trying Mirapex, especially with some of the news around here of late?
I've followed some of your woes as they are very close to mine. Although I didn't react at all to SSRI's, I did find a mild boost from Nortriptyline. I've stayed on that for a number of years now as my primary AD. After a couple of suicide attempts about 3 years ago I was started on Zyprexa. It made a world of difference. Zyprexa cleared up my ruminating thoughts and helped me get through some of my anxiety problems at the same time.
Unfortunately I spent the next few years looking for some way to combat the anhedonia without success. I tried Wellbutrin, Adderall, Ritalin, Provigil, almost anything that was supposed to be activating. Nothing got me over the hump..
Last Dec. I asked my pdoc about Selegiline and we agreed that we would both look at possibilities in Jan. When I went back I had found a lot of info on Mirapex and asked him if I could try it. After a few minutes with the PDR and the studies I gave him, we agreed to try it.
It has been the best thing that's happened to me since Zyprexa. I'm down to Norteriptyline, Zyprexa and Mirapex and for the first time in years I can feel my emotions again. It's been 2 1/2 months now and I still feel the good effects.
I know you have followed some of Mirapex threads but it has been great for my anhedonia problem. It may not be for everyone but you might want to give it a try.
Chris
Posted by JohnX on March 8, 2001, at 8:34:01
In reply to Re: Ziprasidone, could be a good one, posted by ChrisK on March 7, 2001, at 5:53:20
> John,
>
> Just jumping into your conversation with Cece but have you considered trying Mirapex, especially with some of the news around here of late?
>
> I've followed some of your woes as they are very close to mine. Although I didn't react at all to SSRI's, I did find a mild boost from Nortriptyline. I've stayed on that for a number of years now as my primary AD. After a couple of suicide attempts about 3 years ago I was started on Zyprexa. It made a world of difference. Zyprexa cleared up my ruminating thoughts and helped me get through some of my anxiety problems at the same time.
>
> Unfortunately I spent the next few years looking for some way to combat the anhedonia without success. I tried Wellbutrin, Adderall, Ritalin, Provigil, almost anything that was supposed to be activating. Nothing got me over the hump..
>
> Last Dec. I asked my pdoc about Selegiline and we agreed that we would both look at possibilities in Jan. When I went back I had found a lot of info on Mirapex and asked him if I could try it. After a few minutes with the PDR and the studies I gave him, we agreed to try it.
>
> It has been the best thing that's happened to me since Zyprexa. I'm down to Norteriptyline, Zyprexa and Mirapex and for the first time in years I can feel my emotions again. It's been 2 1/2 months now and I still feel the good effects.
>
> I know you have followed some of Mirapex threads but it has been great for my anhedonia problem. It may not be for everyone but you might want to give it a try.
>
> ChrisChris,
Thanks for your insights. I'm most definately looking into any dopaminergic medication or 5ht-2 antagonist. My belief is they I have a hypo-dopmanergic prefrontal cortex. This correlates to my symptoms of tension headaches & anhedonia and the meds that relieved the symptoms Adderall, Serzone, and Klonopin.
I'm a little nervous about trying any meds that may cause EPS, because I got a lot of twitching, rls, and my tension headaches got worse after trying SSRI's. The SSRI's really numbed out my emotions bad. I found evidence that SSRI's in some people can induce hypo-dopaminegic activity
that results in side-effects similar to neuroleptics. My other problem is that meds sometimes induce mania. So I've mainly been using anti-convulsants to stabilize my mood with the lingering anhedonia and tension-headaches to be cured. Unfortunately I just moved for a new job and hit a really bad slump and it took me 6 weeks to get into see a new pdoc and this guy is very stubborn. All my old pdocs were very open to letting me try fringe alternatives. In the mean while I switched to meds that I had prior experience with that I knew would get me 80% back to normal with low risk because I was very concerned about loosing my job. From here I can tinker with adding in all these great new suggestions I've found in this news group.Andrew sent me a great list of meds to try, and it included Mirapex (which I haven't got to yet).
How fast does the Mirapex kick in for you?
-John
Posted by Cece on March 8, 2001, at 13:31:52
In reply to Re: Ziprasidone, could be a good one » Cece, posted by JohnX on March 7, 2001, at 4:15:55
I think that I get more than one kind of headache- sometimes I can clearly identify a migraine, but not that often. I think that many are tension headaches. I haven't really studied headaches all that much- just enough to realize that they can be very hard to track down and categorize, and I already spend enuf time w/doctors. Although I've had headache problems for years (way before I took meds), I think that some of my present ones may be side effects- but it's worth it. Vicodin dulls them and also gives me a mood boost, so it's a regular PRN med for me.
Interestingly, years ago, when I had been having a long, bad spell of headaches, I went on a fairly long vacation- about 3 weeks, mostly low-key camping. I was tired of fighting the headaches and so decided to just let them be, take my time, and let them take up as much room as they wanted. I wasn't trying to "outsmart" them, but about halfway through my vacation I suddenly realized that I wasn't having headaches. A good indication of tension headaches, I think.
Re my sensitivity to bright light- for years I have experienced a kind of reverse SAD. By mid-summer, I am miserable- very depressed, withdrawn, almost completely non-functional. I've always associated it with the bright, glaring light, and secondarily to heat (although where I live the summers are mild), rather than to the length of the days(my pdoc suspects day length however). This last summer, when I was beginning on Lamictal, I actually enjoyed the summer- my lapses into withdrawal were mild enuf that I could push myself out of them. I'm going to be really interested to see what happens this next summer.
I haven't tried Zyprexa- just heard about it here recently. My pdoc thinks that it's worth trying, but becuz of weight problems, I'm waiting for Ziprasidone.
Thanx for the info, and good luck,
Cece
> Yeah I can relate. We want to finish off our episodes and move on with our lifes, but this monkey just won't get off our backs!
>
> I'm wondering what kind of headaches do you get?
> Are they migraine headaches? (Guessing because of
> the sensitivity to noise,light,etc).
>
> When I get past any major depressive or manic
> episodes, I usually normalize into a state of anhedonia (lack of interest or drive) + I always have these lingering tension headaches. My tension headaches go away when I take a stimulant or Klonopin or Serzone. I've nailed it down physiologically to an area of the brain that when hypo-dopaminergic can cause tension, anhedonia, social withdrawl. Meds that block the serotonin
> 5ht-2 receptor will relieve these symptoms (they will increase dopamine indirectly in the problem spot; stimulants like Adderall increases dopamine directly). The 5ht-2 blocker include Serzone, and
> most of the anti-psychotics like Zyprexa. Have you tried Zyprexa? Serzone made me too drowsy, but Ziprasidone is a potent 5ht-2 blocker that seems to not have the Serzone/Zyprexa like side effects.
>
> What do you think?
>
> -John
>
Posted by ChrisK on March 8, 2001, at 14:51:49
In reply to Re: Ziprasidone, could be a good one » ChrisK, posted by JohnX on March 8, 2001, at 8:34:01
John,
I ramped up on Mirapex very quickly so I noticed a difference in about 10 days. All of the literature says to titrate slowly due to the naseau problem that a lot of people see. I went to 3 mg/day (3 doses of 1) in a couple of days. It is reccomendedto start with .75 mg/day and slowly move up. Right now I take 2 mg when I get up and then 1 mg mid morning and another mid afternoon. The original studies of Mirapex as an AD showed that 5 mg/day showed a greater AD effect than lower doses. The only problem was that many of the study patients quit because of side effects.
I'm fairly med resistant so I rarely see a lot of the side effects that force others to quit on a good med.
Hope this helps,
Chris
Posted by Chris A. on March 8, 2001, at 15:43:15
In reply to Re: Ziprasidone, could be a good one, posted by ChrisK on March 8, 2001, at 14:51:49
To all those in waiting,
My pDoc just phoned to say he has some "zip" samples awaiting me. It's finally here!Blessings,
Chris A.
Posted by Sunnely on March 8, 2001, at 20:22:04
In reply to Ziprasidone - available now, posted by Chris A. on March 8, 2001, at 15:43:15
Chris,
Although ziprasidone (Geodon), the newest atypical antipsychotic drug, may be effective in a number of psychiatric disorders aside from schizophrenia, there are important things one should know before taking this drug.
To go back in time, ziprasidone was expected to be released in the fall of 1998. However, Pfizer, the manufacturer, received notification from the US FDA in the summer of 1998 indicating that approval of ziprasidone would be delayed. The primary reason for this non-approval was apparently safety concerns related to potential heart side effects, specifically prolongation of the QTc interval, which has become a controversial issue for new antipsychotics. (Note: Prolongation of QTc on electrocardiogram or ECG is considered a "harbinger" for potentially serious heart beat irregularity ["torsades de pointes"], which could lead to sudden death. Sertindole or Serlect, a very promising atypical antipsychotic did not make it in the US market due to concerns of prolonged QTc. Drugs such as Seldane, Hismanal, and Propulsid, which have been associated with prolonged QTC, "torsades" and sudden deaths have been voluntarily removed from the US market.)
Pfizer did a study directly comparing the QTc prolonging effect of ziprasidone with several other antipsychotic drugs (Risperdal, Zyprexa, Seroquel, and Haldol). The mean increase in QTc from baseline for ziprasidone ranged from approximately 9 to 14 msec (milliseconds) greater than the comparator drugs, but was 14 msec less than the prolongation observed for thioridazine (Mellaril). (Note: Because of this finding, Mellaril got clocked. Subsequently, the FDA required that a "black box" warning be included in the package insert of Mellaril indicating the significant risk of prolonged QTc, "torsades" and sudden deaths. Its clinical indication was also restricted only to schizophrenia and not a first-line antipsychotic.)
In the placebo controlled trials, ziprasidone increased the QTc interval compared to placebo by approximately 10 msec at the highest recommended daily dose of 160 mg.
Based on the above results, the FDA required that Geodon package insert (PI) label warn patients and doctors about prolongation of QTc and risk of sudden death. However, the agency did not require that a severe "black box" warning be placed on the label, a safeguard the agency reserves for drugs deemed to have especially worrisome side effects. Pfizer was able to convince the FDA that patients are not required to undergo ECG prior to and during the maintenance treatment with Geodon.
The following is a patient summary information about Geodon:
WHO SHOULD NOT TAKE GEODON?
Anything that can increase the chance of a heart rhythm abnormality should be avoided. Therefore, do not take GEODON if:
1. You have certain heart diseases, for example, long QT syndrome (acquired or born with), a recent heart attack, severe heart failure, or certain irregularities of heart rhythm (discuss the specifics with your doctor).
2. You are currently taking medications that should not be taken in combination with Geodon, for example, quinidine (Quinaglute), pimozide (Orap), sotalol (Betapace, Sotacor), thioridazine (Mellaril), sparfloxacin (Zagam), or moxifloxacin.
WHAT TO TELL YOUR DOCTOR BEFORE YOU START GEODON?
Be sure you telll your doctor if:
1. have had any problem with the way your heart beats or any heart related illness or disease
2. any family history of heart disease
3. are taking or have recently taken any prescription medicines
4. are taking any over-the-counter (OTC) medicines you can buy without a prescription, including natural/herbal remedies
5. have had any problems with your liver
6. are pregnant, might be pregnant, or plan to get pregnant
7. are breast feeding
8. are allergic to any medicines
9. have ever had an allergic reaction ziprasidone or any of the other ingredients of Geodon capsules.
HOW TO TAKE GEODON?
1. Take Geodon only as directed by your doctor.
2. Swallow the capsules whole.
3. The capsules should be taken with food. (Increases absorption by 60%. If you have been taking it with food then decide to take it on an empty stomach, the absorption and subsequently blood level of Geodon will decrease. This may lead to relapse of your illness.)
4. It is best to take Geodon at the same time each day. (Recommended dosing interval is twice a day.)
5. Do not change your dose or stop taking your medicine without your doctor's approval.
6. Keep taking your capsules, even when you feel better.
NOTIFY YOUR DOCTOR IMMEDIATELY IF YOU (could mean you're having heart rhythm abnormality):
1. Faint or lose consciousness
2. Feel a change in the way that your heart beats (palpitations)
COMMON SIDE EFFECTS OF GEODON:
1. Feeling unusually tired or sleepy
2. Nausea or upset stomach
3. Constipation
4. Dizziness
5. Restlessness
6. Abnormal muscle movements, including tremor, shuffling, and uncontrolled involuntary movements
7. Diarrhea
8. Rash
9. Increased cough/runny nose
DOSING RECOMMENDATIONS:
1. For acute schizophrenic symptoms: A dose of 80 mg to 160 mg (in 2 divided doses) found to be effective. Initial dose is 20 mg twice a day with food. 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.
2. For maintenance treatment in schizophrenia: In a one-year trial of ziprasidone, 40 mg/day dose, which may be too low for acute treatment, appears to be efficacious in maintenance.
3. For depression and anxiety: During Geodon clinical trials with schizophrenic and schizoaffective patients, both 120 mg/day and 160 mg/day (60 mg twice a day and 80 mg twice a day, respectively), doses have been found to significantly improve depression and anxiety symptoms compared to placebo. (Note: Geodon is not approved by the FDA for treatment of depression and anxiety.)
HOW GEODON MIGHT WORK FOR DEPRESSIVE AND ANXIETY DISORDERS?
Geodon is a moderate inhibitor of reuptake of both serotonin and norepinephrine, which is characteristic of many antidepressants, suggesting possible effectiveness in depression and anxiety. Furthermore, Geodon has 5HT1A agonism (like BuSpar), suggesting possible anti-anxiety and antidepressant effects. Although unlikely to be used primarily for anxiety, one double-blind study of predental anxiety compared a single oral dose of Geodon 20 mg to diazepam (Valium) 10 mg in 90 patients. The study found both drugs to be effective in reducing anxiety prior to dental surgery, with Geodon producing less sedatiion. This suggests that Geodon does have anti-anxiety effects which are not due to sedation.
PHARMACOLOGY OF GEODON:
Geodon is a highly potent antagonist of 5HT2A receptors and a less potent antagonist of D2 receptors, with a binding affinity ratio of 5HT2A/D2 which may be higher than any antipsychotic either currently in use or in late stage of development. Geodon is also a potent antagonist of 5HT2C and 5HT1D receptors as well as potent agonist of 5HT1A receptors. It has modest affinity for H1 (Histamine 1) receptors with almost no affinity for M1 (muscarinic, cholinergic) receptors. Its modest affinity for H1 and alpha1 receptors suggests a low risk of sedation and hypotension (drop in blood pressure). Its low affinity for M1 cholinergic receptors suggests a low risk for cognitive side effects.
Geodon is mainly metabolized by the liver enzyme CYP3A4. Theoretically, drugs that inhibit the action of this enzyme such as Erythromycin, nefazodone (Serzone), ketoconazole (Nizoral), cimetidine (Tagamet), some protease inhibitors (drugs for HIV) and grapefruit juice may raise the blood level of Geodon. On the other hand, drugs that induce the action of this enzyme such as carbamazepine (Tegretol), phenytoin (Dilantin), phenobarbital, rifampin (Rifadin), and some protease inhbitors may decrease the blood level of Geodon.
GEODON AND WEIGHT GAIN:
Analysis of data of antipsychotics and weight gain found that among atypical antipsychotics Geodon has the least potential to cause weight gain. The estimated weight gain after 10 weeks of treatment is 0.04 kg for Geodon as compared to 4.45 kg for Clozaril, 4.15 kg for Zyprexa, and 2.10 kg for Risperdal.
GEODON MAY BE EFFECTIVE IN TOURETTE'S DISORDER:
One double-blind placebo-controlled pilot study of Geodon in patients with Tourette's disorder aged 7-17 years found that Geodon (16 patients) in flexible doses of 10-40 mg/day was superior to placebo (12 patients) in reducing the severity and number of tics.
FWIW, originally ziprasidone was to named commercially as Zeldox. But the FDA asked Pfizer to choose a different name to avoid being mistaken for other drugs with sound-alike names, e.g., Zyvox, an antibiotic.
++++++++++++++++++++++++++++++
> To all those in waiting,
> My pDoc just phoned to say he has some "zip" samples awaiting me. It's finally here!
>
> Blessings,
>
> Chris A.
Posted by Chris A. on March 8, 2001, at 21:31:57
In reply to Ziprasidone: Not so fast. » Chris A., posted by Sunnely on March 8, 2001, at 20:22:04
Thanks for letting me read the PDR info tonight instead of having to wait until tomorrow :)
My pDoc suggested taking it without food so the dose would be lower, as I am extremely sensitive to APs.
Also, for some of us, the ongoing risk of death by suicide far outweighs any concern over prolonged QT intervals. It's been over twenty years ago that I was a coronary/critical care nurse, but my experience causes me to believe it is much more dangerous to get in your car everyday and drive than to take some of these meds. Those with coronary risk factors need to get those checked out. Frankly, I wonder if some of the meds that cause high rates of weight gain (depabloat, olanzaspan, tegreball, lithigain, clozaroll - etc., etc.) actually contribute to more coronary deaths. There are multiple health risks that are compounded by obesity. It's important to stand back and look at the whole picture every once in a while.
Ziprasidone was the first recommendation my university consultant made when I saw him nearly two years ago "As soon as it's available here..." It's been a long wait and I hope not to be disappointed. It would be nice to feel normal (whatever that is) for a change. I am tired of the pain.
Chris A.
Posted by Sunnely on March 9, 2001, at 0:01:57
In reply to Re: Ziprasidone: Been waiting forever » Sunnely, posted by Chris A. on March 8, 2001, at 21:31:57
Hi ChrisA,
I'm glad that your patience is rewarded and that the waiting is finally over.
I'm not trying to dash your hope with ziprasidone. Just trying to dessiminate factual info about the drug. IMHO, the best patients (consumers) are the well-informed ones. Like you, I strongly believe that ziprasidone will ease the ineffable "pain" of depression (and schizophrenia) suffered by countless unfortunate people.
Best of luck to you.
++++++++++++++++++++++++++
> Thanks for letting me read the PDR info tonight instead of having to wait until tomorrow :)
>
> My pDoc suggested taking it without food so the dose would be lower, as I am extremely sensitive to APs.
>
> Also, for some of us, the ongoing risk of death by suicide far outweighs any concern over prolonged QT intervals. It's been over twenty years ago that I was a coronary/critical care nurse, but my experience causes me to believe it is much more dangerous to get in your car everyday and drive than to take some of these meds. Those with coronary risk factors need to get those checked out. Frankly, I wonder if some of the meds that cause high rates of weight gain (depabloat, olanzaspan, tegreball, lithigain, clozaroll - etc., etc.) actually contribute to more coronary deaths. There are multiple health risks that are compounded by obesity. It's important to stand back and look at the whole picture every once in a while.
>
> Ziprasidone was the first recommendation my university consultant made when I saw him nearly two years ago "As soon as it's available here..." It's been a long wait and I hope not to be disappointed. It would be nice to feel normal (whatever that is) for a change. I am tired of the pain.
>
> Chris A.
Posted by Chris A. on March 9, 2001, at 0:11:58
In reply to Re: Ziprasidone: Been waiting forever » Chris A., posted by Sunnely on March 9, 2001, at 0:01:57
Thanks for being so kind. Sorry I sounded so grumpy. I have appreciated the accurate information you have imparted on this board. After nearly thirty years of reading it, the PDR print is getter smaller and I am getting weary of the whole thing. Perhaps that can be attributed to my depressed mood.
Keep up the good work!
Chris A.
Posted by SLS on March 9, 2001, at 9:51:19
In reply to Ziprasidone: Not so fast. » Chris A., posted by Sunnely on March 8, 2001, at 20:22:04
Dear Sunnely,
Regarding cardiac function, what are your thoughts about combining Geodon with a tricyclic antidepressant? I am considering adding it to nortriptyline.
Thanks.
- Scott
Posted by Sunnely on March 9, 2001, at 16:32:30
In reply to Re: Ziprasidone: Not so fast. » Sunnely, posted by SLS on March 9, 2001, at 9:51:19
Hi Scott,
If you are a young healthy individual without pre-existing heart disease, the combination of nortriptyline (blood level at therapeutic range) and Geodon (at recommended dose) is considered generally safe.
Most of the prolonged QTc I encountered with the use of tricyclic antidepressants are with the elderly people and in those who intentional overdosed (suicide attempts). In one case, a 62 year-old-female who consumed alcohol then overdosed on Elavil (further metabolized to nortriptlyline) estimated over 1000 mg, developed a prolonged QTc but unfortunately progressed to "torsades" which further deteriorated into ventricular fibrillation. Emergency measures instituted failed to revive her.
What is prolongation of QTc? In normal heart conduction, the QTc interval lasts approximately 420 ms (milliseconds). However, if repolarization is delayed, prolongation of the QT interval results. In general, a QTc longer than 450 ms is of potential concern. Prolongation longer than 500 ms indicates an elevated risk of progression to tachyarrhythmias ("torsades des pointes"), which may be associated with symptoms such as palpitations, dizziness, lightheadedness, and syncope; and progression to ventricular fibrillation, which can potentially cause sudden death. Prolonged QTc in itself is not the main problem. However, this ECG abnormality is considered a "harbinger" to a more serious arrhythmia ("torsades") and even sudden death. (If you are on Geodon, it is important to immediately notify your doctor if you experience palpitations, dizziness, lightheadedness, and syncope.)
Aside from the elderly, other risk factors to the development of prolonged QTc include the following:
1. Electrolyte imbalance (particularly low potassium or magnesium levels). This may result from diuretic and excessive vomiting/diarrhea. (People with eating disorders may be more prone).
2. Genetic - Those born with long QT syndrome.
3. Heart disease such as acute or chronic myocardial ischemia, heart rhythm irregularities (arrhythmias), and congestive heart failure.
4. Drugs known to prolong QTc interval such as thioridazine (Mellaril), mesoridazine (Serentil) which is a metabolite of Mellaril, sertindole (Serlect), terfenadine (Seldane), astemizole (Hismanal), grepafloxacin (Raxar), and cisapride (Propulsid).
5. Medication overdose with drugs that prolong QTc. (Tricyclics may cause prolonged QTc in overdoses. It is important to monitor ECG and the tricyclic blood levels. Potentially serious effects on the heart from tricyclic overdoses could last from 1-5 days.)
6. Drug-drug or drug-drink interactions. Some of the reported sudden deaths from the use of Seldane and Hismanal (both removed from the US market) were taken with grapefruit juice (GJ). Although Pfizer does not indicate this in their package insert (PI) and there is no study regarding this combination, it is probably clinically prudent to avoid GJ while one is on Geodon since GJ is a potent inhibitor of the enzyme CYP3A4, the same enzyme that Geodon depends on for metabolism. There are other drugs that are known to potent inhibitors of CYP3A4, therefore you should consult with your doctor or pharmacist before combining them with Geodon.
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> Dear Sunnely,
>
> Regarding cardiac function, what are your thoughts about combining Geodon with a tricyclic antidepressant? I am considering adding it to nortriptyline.
>
> Thanks.
>
>
> - Scott
Posted by ShelliR on March 9, 2001, at 21:30:32
In reply to Re: Ziprasidone: Not so fast., posted by Sunnely on March 9, 2001, at 16:32:30
Three questions re ziprasidone:
(1) Is the risk of td the same as for the other atypical antipsychotics? Any information out about that?
(2) I have read a lot about the things that make the risk of td greater (e.g, age, duration of taking medication, etc.). Everything I read says, "the risk is much smaller with atypical antipsychotics" or the risk is "very small".
I can't find any real statistics. Even in a release about resperidal (sp?), the results presented were again a comparison against older antipsychotics, AND said "significantly lower" AND the study was only three months long. So in three months some people obviously developed TD. I am keeping in mind that the subjects of this study were schizophrenic and I believe took at least 10mg. But still, this is just a three month period. So what does a smaller percentage actually mean? One percent, five percent? Or is this not known exactly because no one really wants to do a study to find out.(3) I have tried all the other atypical antipsychotics (except zyprexa because of fear of weight gain) and have not been able to tolerate any of them. Has anyone else not been able to tolerate one because of side effects yet tolerate another--sort of like ads in general.
I am not trying to be an alarmist. I am just trying to make an educated decision on whether to try ziprsidone. And I feel frustrated at the constant reference to "smaller risk" because I don't know how to evaluate that.
Thanks for any replies. Shelli
This is the end of the thread.
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