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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by anita on April 22, 2001, at 9:10:22
Hiya,
I took just one 20mg dose of Geodon and had terrible nausea, as well as a runny nose and tearing eyes. I even dreamt I was vomiting. I'm going to try dissolving the powder in water and take half the dose, I guess. Do you know if this side effect tends to go away over time? I had high hopes for this med and am really distressed that I can't seem to tolerate it.
thanks,
anita
Posted by SLS on April 22, 2001, at 13:24:56
In reply to Geodon and nausea, anyone?, posted by anita on April 22, 2001, at 9:10:22
> Hiya,
>
> I took just one 20mg dose of Geodon and had terrible nausea, as well as a runny nose and tearing eyes. I even dreamt I was vomiting. I'm going to try dissolving the powder in water and take half the dose, I guess. Do you know if this side effect tends to go away over time? I had high hopes for this med and am really distressed that I can't seem to tolerate it.
>
> thanks,
> anita
Hi Anita.I am VERY disappointed for you. I don't understand the runny nose and tearing eyes yet. Maybe the nausea and these other things are the result of the significant antagonism of 5-HT1D receptors that ziprasidone demonstrates. Do you also have a headache? I guess you'll have to wait for some feedback to see if these are transient start-up side effects. I'm sure you know that nausea is consistently listed in clinical studies to be one of the three most frequent adverse effects. I doubt you will want to go this far, but you might be able to mitigate these side effects by using sumatriptan, a 5-HT1D agonist. Perhaps ondansetron, a 5-HT3 antagonist, would be useful. I wonder if the nausea is more prominent at very low dosages, including the beginning of a titration to a higher dosage. D2 presynaptic autoreceptor antagonism? Probably a silly thought.
Sorry. I doubt that anything I wrote is of any practical use. More heuristic, I guess.
Short rant:I am wondering just what exactly is going on with this NE and 5-HT reuptake inhibition stuff with ziprasidone. I can't find anything except for the following often-cited study. I believe it was an 'in vitro' experiment using synaptosomes at possibly irrelevant high concentrations. I would like to see some cooraborative data before considering reuptake inhibition to be a putative functional 'in vivo' property of ziprasidone. What does Dr. Stahl use as his sources of information regarding this?
I hope things work out with ziprasidone. You deserve a break.
- Scott
-------------------------------------------------------------------Seeger TF, et al. Ziprasidone (CP-88,059): A new antipsychotic with combined dopamine and serotonin receptor antagonist activity. J Pharmacol Exp Ther 1995;275:101-113
-------------------------------------------------------------------
Posted by Sunnely on April 22, 2001, at 18:02:15
In reply to Geodon and nausea, anyone?, posted by anita on April 22, 2001, at 9:10:22
Hi Anita,
Geodon and nausea: Initial nausea can occur in 20% of patients on Geodon. It tends to occur in the first 2 weeks of treatment and then to subside on its own. The nausea appears to be sensitive to dosing adjustments and responds to a lowering of the dose or giving Geodon with meals. (Incidentally, taking Geodon with food not only alleviates nausea but also increases its absorption and "biovailability." I will not suggst dissolving Geodon capsule powder in water. May worsen nausea. You don't need to take Geodon with full meals. Geodon with snacks or even milk, if you can tolerate it, is OK, too.)
Geodon and respiratory symptoms: Approximately 5% of patient on Geodon report some form of "respiratory disorder" - described as "cold symptoms" including nasal stuffiness ("rhinorrhea"). This symptom tends to subside on its own.
Other common side effects of Geodon is insomnia and "awakening effects."
Geodon and Insomnia: Insomnia tends to occur in about 50% of patients started on Geodon. It usually happens soon after the start or switch to Geodon - within a few days to the first week. Ways to alleviate Geodon-induced insomnia include: 1) adding a benzodiazepine for sleep. For example 2-3 mg of lorazepam (Ativan) at bedtime. Once the insomnia has abated, lorazepam can then be tapered and discontinued. It takes about 3-4 weeks on its own for insomnia to abate; 2) give more Geodon in the morning and less in the evening; and 3) postpone increasing Geodon dose until insomnia resolves.
Geodon and "Awakening" reactions: In some, Geodon "awakening" can be quite dramatic, perhaps due to combination of clinical response and decreased sedation, so that the patient is more awake. Patients who experienced Geodon "awakening" seems to be much more talkative about their inner emotional life. My hunch is, its reuptake inhibition of serotonin and norepinephrine may be playing a major role.
++++++++++++++++++++++++++++++++++
> Hiya,
>
> I took just one 20mg dose of Geodon and had terrible nausea, as well as a runny nose and tearing eyes. I even dreamt I was vomiting. I'm going to try dissolving the powder in water and take half the dose, I guess. Do you know if this side effect tends to go away over time? I had high hopes for this med and am really distressed that I can't seem to tolerate it.
>
> thanks,
> anita
Posted by SLS on April 22, 2001, at 19:30:00
In reply to Re: Geodon and nausea, anyone? » anita, posted by Sunnely on April 22, 2001, at 18:02:15
Dear Sunnely,
> My hunch is, its reuptake inhibition of serotonin and norepinephrine may be playing a major role.
How do you know it does that?
- Scott
Posted by Sunnely on April 22, 2001, at 22:35:17
In reply to Re: Geodon and nausea, anyone? » Sunnely, posted by SLS on April 22, 2001, at 19:30:00
Scott,
I am sure you know that Geodon is both a reuptake inhibitor of serotonin and norepinephrine. This, along with its other pharmacologic actions, 5-HT1D antagonist and 5-HT1A agonist, would predict antidepressant and anxiolytic actions as well.[1,2]
I have no scientific study to support my hunch. But allow me to express my 2-cent opinion. Between the 2 (serotonin and norepinephrine), Geodon's reuptake norepinephrine inhibition is most probably the main player. Antidepressants with norepinephrine reuptake inhibition tend to be more activating than sedating. For example, bupropion (Wellbutrin) tends to aggravate the anxious or "agitated" type of depression but a good choice for the "retarded" type of depression. Reboxetine (Vestra, Edronax) is a selective norepinephrine reuptake inhibitor which is also activating, along with its effect on the heart (tachycardia or rapid heart beat and increased in blood pressure). Although venlafaxine (Effexor) is both serotonin and norepinephrine reuptake inhibitor, at higher doses (e.g., >300 mg/day), the norepinephrine effect takes over and therefore, more activating. Also at this dose, it tends to increase blood pressure. This is the reason why it is recommended to check blood pressure periodically if Effexor is used >300 mg/day.
Although Geodon may be effective in depressed schizoaffective or bipolar patients, theoretically, there is a risk of inducing mania or rapid-cycling because of its serotonin and norepinephrine reuptake inhibition.
Again, above opinion is just a "hunch" and needs to be supported by scientific study.
References:
1. Package Insert, Geodon (ziprasidone HCl), Pfizer, February 2001.
2. Essential Psychopharmacology, 2000, second ed., Stephen M. Stahl, Cambridge University Press, Cambridge, UK.
++++++++++++++++++++++++++++++++++
> Dear Sunnely,
>
> > My hunch is, its reuptake inhibition of serotonin and norepinephrine may be playing a major role.
>
> How do you know it does that?
>
>
> - Scott
Posted by SLS on April 23, 2001, at 18:26:18
In reply to Re: Geodon and nausea, anyone?, posted by Sunnely on April 22, 2001, at 22:35:17
Dear Sunnely,
> Again, above opinion is just a "hunch" and needs to be supported by scientific study.
>
> References:
>
> 1. Package Insert, Geodon (ziprasidone HCl), Pfizer, February 2001.
>
> 2. Essential Psychopharmacology, 2000, second ed., Stephen M. Stahl, Cambridge University Press, Cambridge, UK.
>
> ++++++++++++++++++++++++++++++++++
I apologize for the misunderstanding. My wording of the question pretty much sucked.I was not asking you about your hunch. Based upon the supposition that ziprasidone inhibits the reuptake of norepinephrine and serotonin, it seems very reasonable.
> I am sure you know that Geodon is both a reuptake inhibitor of serotonin and norepinephrine.
That's just the thing. I'm not. I am not contending otherwise, but I want to see the data resulting from experiments, not just a repetitive pronouncement of the acceptance of these properties as being putative. It might be important information to be considered when making a decision to combine ziprasidone with an MAO inhibitor.
I would like to see any references that may be cited in the package insert. I believe that I have come across instances in the past where a single physiological study has served as the basis for subsequent statements and considerations. I would like to know that there are some experiments that demonstrate and corroborate the contention that ziprasidone is a reuptake inhibitor other than this one study that I found cited in a piece I found on the Internet:
Seeger TF, et al. Ziprasidone (CP-88,059): A new antipsychotic with combined dopamine and serotonin receptor antagonist activity. J Pharmacol Exp Ther 1995;275:101-113.
Since I read in another piece that alluded to previous work demonstrating reuptake inhibition using 'in vitro' synaptosomal preparations, I am guessing that they were referring to the Seeger study. I couldn't find the abstract on Medline.
What is the source of Dr. Stahl's information?
Now, having said and asked all of that, I want to thank you very much for supplying the information and your perspective to Anita. Your post provided her with true guidence and support, something I was then incapable of. You have also helped me because I might try ziprasidone in the near future.
Thanks again.
Sincerely,
Scott
This is the end of the thread.
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