Preparation for Child Psych PRITE and Boards
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==Geodon in children== | ==Geodon in children== | ||
| + | * Ziprasidone has a greater propensity for QTc prolongation than other atypicals' careful history of congenital long QTc syndrome and heart disease is very important. | ||
| + | * Weight gain, prolactin elevation and EPS are not as significant as with some of the other atypical antipsychotics. | ||
| + | * Geodon has no FDA indication for use in children and adolescents, but is widely used off-label (often as second-line medication) for PDD-associated symtpoms, mood disorders, DBDs, eating disorders, OCD, MR, and thought disorders. | ||
==High-yield facts== | ==High-yield facts== | ||
* PO Geodon should be taken with food: GI absorption is significantly lower in the fasting state | * PO Geodon should be taken with food: GI absorption is significantly lower in the fasting state | ||
| − | * Geodon is liver-metabolized by aldehyde oxidase; CYP 3A4 enzymes play a secondary role, and thus carabamezapine can decrease and ketoconazole can increase blood levels of Geodon. | + | * Geodon is liver-metabolized by aldehyde oxidase (about two-thirds); '''CYP 3A4 enzymes''' play a secondary role (about a third), and thus carabamezapine can decrease and ketoconazole can increase blood levels of Geodon. |
* Just like other 2nd-gen antipsychotics, Geodon has a black-box warning for increased mortality in elderly with dementia. | * Just like other 2nd-gen antipsychotics, Geodon has a black-box warning for increased mortality in elderly with dementia. | ||
===Black belt facts=== | ===Black belt facts=== | ||
| − | * The absorption of Geodon is increased two-fold in the presence of food. | + | * The absorption of Geodon is increased two-fold in the presence of food (from ~30% to 60%). |
**At least '''500kcal''' is necessary to ensure therapeutic concentration at predictable (dose-dependent) levels. | **At least '''500kcal''' is necessary to ensure therapeutic concentration at predictable (dose-dependent) levels. | ||
** common advice to take Geodon with a snack is misleading: an apple is 100 Cal, granolar bar is about 150. | ** common advice to take Geodon with a snack is misleading: an apple is 100 Cal, granolar bar is about 150. | ||
Latest revision as of 22:28, 2 December 2012
Introduction
Geodon in children
- Ziprasidone has a greater propensity for QTc prolongation than other atypicals' careful history of congenital long QTc syndrome and heart disease is very important.
- Weight gain, prolactin elevation and EPS are not as significant as with some of the other atypical antipsychotics.
- Geodon has no FDA indication for use in children and adolescents, but is widely used off-label (often as second-line medication) for PDD-associated symtpoms, mood disorders, DBDs, eating disorders, OCD, MR, and thought disorders.
High-yield facts
- PO Geodon should be taken with food: GI absorption is significantly lower in the fasting state
- Geodon is liver-metabolized by aldehyde oxidase (about two-thirds); CYP 3A4 enzymes play a secondary role (about a third), and thus carabamezapine can decrease and ketoconazole can increase blood levels of Geodon.
- Just like other 2nd-gen antipsychotics, Geodon has a black-box warning for increased mortality in elderly with dementia.
Black belt facts
- The absorption of Geodon is increased two-fold in the presence of food (from ~30% to 60%).
- At least 500kcal is necessary to ensure therapeutic concentration at predictable (dose-dependent) levels.
- common advice to take Geodon with a snack is misleading: an apple is 100 Cal, granolar bar is about 150.
- Fat content of the food is not important.
- Increasing the PO dose does not compensate for lower absorption when on an empty stomach.
- i.e.doubling the evening dose when one has to skip dinner is not a working strategy
References
Thombre AG. Improved Ziprasidone Formulations with Enhanced Bioavailability in the Fasted State and a Reduced Food Effect. Pharm Res 2011