ACK! GEODON!

[GroovyGwen]

WHAT. THE. FUDGE.

This time of year I historically need something to smooth me out and make me not completely destructive. So I started 20mg geodon as a replacement for Abilify, which doesn't allow me to sit down, like ever. I took 20mg tuesday evening, then 20mg Wednesday morning. Tuesday evening I fell asleep OK - but at about 3AM I was AWAKE. You know how you just wake up like someone was shaking you? Not the gradual, semi-awake state of "Hmm, I may be waking up", but "Hello! I'm awake!" Complete with racing thoughts and anxiety. I got up and did some crocheting and eventually fell back asleep for a few hours before work.

So last night, I go to sleep OK around 11, then at 4AM - BAM! I'm AWAKE! (See description above) Same thing, I get up, do some crocheting (crotch-ette-ing is how I enjoy saying it) and try to fall back asleep around 5:30. Then at 6:27 - BAM! I'm awake. Crap. Not a huge deal because I had to get up at 6:35, but still.

So my question (yes I have one in addition to my b*tching) is: If Geodon has a half life of 7 hours, what the HELL is it doing waking me up 20hrs after I take it???

Plus, this morning (like now) I am HAPPY! Wayyyyy HAPPY! Dancing, singing, "Gottaaah Daaaance!!" happy! I didn't take the Geodon this AM and have a call in to my doc but my WORD. What the hell is an AAP doing making me like this? (Yes, I know it's on the PI sheet as a possible side effect, but isn't that counter-productive?) At least I'm not depressed and rapid, but happy and rapid gets scary as we all know. Hmmm... I probably shouldn't be drinking all this coffee on top of it...

The options are to go back on Abilify and just not sit down for awhile, go way back in the Med history closet to Seroquel which knocks my shit OUT even at 25mg... Or try something else all together. My doc sooooooo won't give me benzos or anything that has even a remote chance of abusing, he's on to me.

I guess this is mostly a rant. Partly me getting some energy out by being witty (is it working?). I should go back to work now. But who the heck wants to type up a spreadsheet when you could be tap dancing?????? Not that I know how to tap dance, but it amuses me (and probably embarrasses me) to fake it.

BEEEEEEEEEE HAPPPPPPYYYYYYYYYYYY!!!!!!!!!

[GroovyGwen]

ummmm.......

I just realized I've been taking twice the dose of Robitussin (the non-alcohol kind). Would that make me crazy? But the last time I took it was at 5AM or something and I'm crazy almost 6 hours after when it's supposed to wear off after 4????? I'm just thinking of that South Park episode. Man, that was funny. If for no other reason, the wigs they wear.... but I digress...

[zenbean]

gwen, i've never been on geodon so i have no earthly clue if it's what's making you feel this way...but yeah, i'm finding your wittiness highly entertaining and i wish i could see you tap dancing...do you have a webcam, perhaps? i'm in a similar situation because i've just been put on an enforced break from lexapro which was making me super-speedy due to not yet being stabilized enough on topamax (maybe - who the hell knows - i don't and i'm starting to suspect my pdoc doesn't either) - but it's more that weird mixed speedy and not happy speedy, unfortunately (although i know well how fast happy speedy can get scary speedy).

ok, so much for this totally superfluous and unhelpful post - just wanted to let you know someone out here's reading you and you made me laugh - hope you're doing ok and you know the drill, if it gets too scary or out of control, call the pdoc posthaste, even if s/he also has no goddamn clue what's going on - either that, or install full length mirrors in your living room, and tap your little heart out.

[crazynotstupid]

Y'know...I ended up going off geodon cuz it made me extremely tired during the day. BUT part of that may have been because, at the beginning, I had one HELL of a time sleeping.

I tried changing the time I took it but it just played such hell with me at work it had to be dropped right quick. Up all night, sleep all day--good song, bad way to live with an 8-5 job.

[Velvet Elvis]

Keep in mind what halflife means. Pharmacokineticly (is that a word?) speaking it's the time required for the ativity of a pharmacological agent to decrease by half. If the rate of decay is logarithmic as it is in the case of nuclar crap, 20 hours for a 7 hour half life could well be the point at which rebound symptoms kick in. I know when I took it that's around the point at which I'd notice if I missed a dose.

Also, most pdocs don't know this, but it must be taken along with a fatty food to be fully absorbed. We're talking fried chicken, not a glass of skim milk. If you're not taking it that way, you're not getting the full dose resulting in a shorter halflife.

[Antiks]

Also, most pdocs don't know this, but it must be taken along with a fatty food to be fully absorbed. We're talking fried chicken, not a glass of skim milk. If you're not taking it that way, you're not getting the full dose resulting in a shorter halflife.

I'd like to see your source for this? None of the things that I've read (save for one random website, which name I can't remember) have ever said anything about you having to eat fatty food. My prescription bottles all say "take with food". I find it hard to believe that they would not tell you that fatty foods were essential to the metabolization process of Geodon.

How could most Pdocs be ignorant of this? They're trained in a field that we aren't, that requires YEARS of schooling and hard work to achieve. Sorry, but I'm not buying it.

[mrsloony]

just for anecdote- geodon started with giving me extreme horrible akathesia which i'd never had before. It then induced a full blown manic state within only a few days. needless to say i stopped it and will not be trying it again.

[Wooster]

most pdocs don't know this, but it must be taken along with a fatty food to be fully absorbed. We're talking fried chicken, not a glass of skim milk.

My psyNP suggested 1-2 oz of cheese for optimal absorption. Info is, if I remember correctly, available in the most current PI sheet available from pfizer.com

[crazynotstupid]

How could most Pdocs be ignorant of this? They're trained in a field that we aren't, that requires YEARS of schooling and hard work to achieve. Sorry, but I'm not buying it.

My pdoc is great, dude. I mean he's awesome in SO many ways. But they are ALL human. Which is why I was the one that told him that topamax increases lithium serum levels...amongst other things.

See, I (shit, WE) have alllll this time to check out these meds. Maybe, hey, for shits and giggles I just punch up every med I ever took into an interaction checker...then a little-known interaction pops out...then at some point, I end up taking that combo, hey! I know what's gonna happen! I have the printout! And yeppers, my pdoc pulls out the PDR, and there it is!

Whereas my pdoc, well, he has to take care of...how many patients? Dunno, he's not accepting any more, must have a bunch. There's continuing education and shit; he's a solo practice, not like there's a lot of slack that can be left for others. Maybe he'd like some personal time.

Seriously--docs can't know ALL the niggling little shit about ALL the drugs they Rx. Fuck, I'm diabetic, my pdoc just let another AAP that fucks with blood sugar pass by. Whatever. You shoot, sometimes you score, sometimes you brick.

[Antiks]

How could most Pdocs be ignorant of this? They're trained in a field that we aren't, that requires YEARS of schooling and hard work to achieve. Sorry, but I'm not buying it.

My pdoc is great, dude. I mean he's awesome in SO many ways. But they are ALL human. Which is why I was the one that told him that topamax increases lithium serum levels...amongst other things.

See, I (shit, WE) have alllll this time to check out these meds. Maybe, hey, for shits and giggles I just punch up every med I ever took into an interaction checker...then a little-known interaction pops out...then at some point, I end up taking that combo, hey! I know what's gonna happen! I have the printout! And yeppers, my pdoc pulls out the PDR, and there it is!

Whereas my pdoc, well, he has to take care of...how many patients? Dunno, he's not accepting any more, must have a bunch. There's continuing education and shit; he's a solo practice, not like there's a lot of slack that can be left for others. Maybe he'd like some personal time.

Seriously--docs can't know ALL the niggling little shit about ALL the drugs they Rx. Fuck, I'm diabetic, my pdoc just let another AAP that fucks with blood sugar pass by. Whatever. You shoot, sometimes you score, sometimes you brick.

My point is that some of this info that's floating around in internet land might be suspect because the information isn't backed up by science, but by rumor. I'm looking for a credible source for the origin of said information regarding Geodon needing to be taken with fatty food sources for full benefit. The PI sheet doesn't say that. I looked. It just says "food". Pretty non-specific if you ask me.

[crazynotstupid]

My point is that some of this info that's floating around in internet land might be suspect because the information isn't backed up by science, but by rumor. I'm looking for a credible source for the origin of said information regarding Geodon needing to be taken with fatty food sources for full benefit. The PI sheet doesn't say that. I looked. It just says "food". Pretty non-specific if you ask me.

Sure. I see your point.

BUT. Consider what gets put on the PI sheet--I just got put on risperdal. Besides clozaril, the only AAP I haven't been on. Talking with my doc, he mentioned ALL AAPs have been "black boxed" for blood sugar warnings--brought only cuz I mentioned invega, which I'd just tried, had a warning on it's PI sheet. Now I stopped invega cuz of the price. It did nothing to my glucose nor did abilify. now zyprexa DID and there's a HUGE lawsuit in the works cuz of its liklihood to cause type 2 diabetes on long term use; I'm a type 1, so you see MY concern. But IMO black boxing ALL AAPs is ridiculous without proving their effects--largely cuz it may well effect the use of them by peopple like me. Really--I don't want to use something like zyprexa again. Why would I want risperdal or invega if I thought it would fuck me like zyprexa?

But abilify didn't. So who says THEY would? My POINT is--the PI sheet, um...doesn't necessarily MEAN a whole lot. It only combines current accepted knowledge with current well, lawsuits. If I manufactured an AAP and I saw this zypraxa lawsuit I would certainly add a blackbox warning. I wouldn't, however, care one diddlysquat about telling people to take a pill with fatty food vs. plain ol' food.

Nor would I care to spend umpteen dollars to research the difference. Seriously. I DO have a business degree. Four years and $50,000+ tells me a mega pharma co doesn't care too much if food vs. fatty foos helps a tidge if it means they have to spend like $200k or $500k or whatever.

They already MADE the product. And it has SOLD. If someone else wants to do some research and prove it--cool. Maybe they'll add it into a later PI sheet.

And maybe you'll get like an Associate's in business.

Just...quit trying to tell us that ONLY the pharma co's are the last word on what "is" and what "ain't" on a pill.

[Silver]

The effect of food on the absorption of oral ziprasidone. Pfizer says (as of this fall) food's important, fat content isn't.

The effect of timing of a standard meal on the pharmacokinetics and pharmacodynamics of the novel atypical antipsychotic agent ziprasidone. This is an older study, and it was widely spread about by the reps. Note design. Fasting or high-fat. No lower-fat meal to look at dose-response effect.

Effect of meal size and fat content on oral ziprasidone absorption

My library doesn't get this fulltext, so I can't quote to you.

[SunshineOutside]

VE,

For some reason I haven't been able to grasp the term half life. If the half life is seven, wouldn't the drug be out of your system at fourteen hours?

What am I missing?

I could use your help (or any body's) on this one.

Brain Blocked,

SO

[Silver]

Half-life is the time it takes for a 50% decline in drug level. It is a progressive series of fractions, which is why the drug is not at 0% after 2 intervals.

Half-life is determined from both clearance and volume of distribution.

Volume of distribution (Vd) is subtle and individual. Vd can be affected by many things: age, obesity, muscle mass, gender, pregnancy...

Clearance can be hepatic or renal, which is why you see "renal dosing" and "hepatic dosing" guidelines for patients with kidney or liver dz. These, too, are individual. For example, hepatic clearance is determined by hepatic blood flow and by 'intrinsic clearance' (which is determined by the enzymes, which are themselves highly variable d/t genetics and other drugs.)

Example of a fictional 8h half-life drug:

1st 8h: 50% clears, leaving 50%

2nd 8h: Half of that clears, leaving 25%

3d 8h: Half of that clears, leaving 12.5%

etc.

This is why 4-5 half-lives are the very vague and non-binding rule of thumb for either complete clearance or to reach steady state.

HOWEVER. Life is, of course, not that simple. THe method described above is an example of first-order clearance.

In zero-order kinetics, however, the metabolic pathways responsible for clearing the drug generally become saturated. (Think Scotty in the Enterprise. "She's goin' as fast as she kin, Cap'n! She canna take no more!") Therefore, the effective half-life can change depending on the saturation or induction of enzymes.

The most well-known example of zero-order clearance is alcohol, which saturates pretty quickly. This means that the body clears a constant amount of alcohol in a given time. If I drink 2 shots in rapid succession, my BAC will drop by about 0.2 mg/dL/hour (more or less.) If I drink 20 shots in rapid succession, myBAC will drop by.. about 0.2/hour (more or less.) Except that I would be dead.

Tegretol is famous for auto-induction, which means that, as you continue taking it, your liver enzymes speed up to keep pace - to their limit. Therefore Tegretol is both a zero-order and first-order drug. There are other drugs that switch from first-order to zero-order at high doses.

Does that help? That's my pre-coffee description of half-life and kinetics, so I'm pretty sure I left out some big pieces.

I'm not getting into protein binding and degree of ionization right now. Coffee first.

[Antiks]

And maybe you'll get like an Associate's in business.

Just...quit trying to tell us that ONLY the pharma co's are the last word on what "is" and what "ain't" on a pill.

*sigh*

I have zero degrees. Degrees don't make much of a difference in this discussion to me unless one is a pharmacist or a pdoc. If this was an insult on your part, then thanks. I really didn't deserve it for asking you and others to back up your info with credible sources.

I have never ever said that Pharma is the last word on what is and what isn't on a pill. That is a credible source, but not the last word on it. I would accept any scientific study on Geodon that backs your source.

[Velvet Elvis]

Also, most pdocs don't know this, but it must be taken along with a fatty food to be fully absorbed. We're talking fried chicken, not a glass of skim milk. If you're not taking it that way, you're not getting the full dose resulting in a shorter halflife.

I'd like to see your source for this? None of the things that I've read (save for one random website, which name I can't remember) have ever said anything about you having to eat fatty food. My prescription bottles all say "take with food". I find it hard to believe that they would not tell you that fatty foods were essential to the metabolization process of Geodon.

How could most Pdocs be ignorant of this? They're trained in a field that we aren't, that requires YEARS of schooling and hard work to achieve. Sorry, but I'm not buying it.

This is what I was thinking of. Sorry it took so long to get back to it. I've been ubercrappy and MIA recently, part of why I couldn't be bothered to cite it when I made the above post.

http://thelastpsychiatrist.com/2007/02/geo...is_not_bid.html

While he writes anonymously, he does give some idea as to his credentials and after having read him for a while I have no reason to think he's anything other than what he says he is.

my point is that some of this info that's floating around in internet land might be suspect because the information isn't backed up by science, but by rumor. I'm looking for a credible source for the origin of said information regarding Geodon needing to be taken with fatty food sources for full benefit. The PI sheet doesn't say that. I looked. It just says "food". Pretty non-specific if you ask me.

That's perfectly valid, IMHO.

[Silver]

VE - I quite like TheLast, and, like you, I have no reason to doubt he's legit.

I had always heard the high-fat food tip as well.

The second article that I listed above was the reference most commonly cited to support that statement.

The first article I listed, which came out within the last month or two, contradicts that, and it is the only article I found which varied the fat concentration and then assessed response. If anyone finds another study of similar design, I'd love the reference, by the way.

Because ziprasidone is quite lipophilic, the model had been that it needs fat for absorption (as is common with lipophilic drugs.) The earlier studies used higher-fat meals as the standard, presumably for this reason.

I recognize that the newer paper is indeed a Pfizer study, and thus should be viewed with appropriate skepticism. However, I can't see a lot of incentive for them to lie about this one thing. Lots of other things, yes, but not this. Hell, it's almost a marketing point.

So, not to sound like I'm trying to placate all sides (b/c I'm not), but: Most of us were operating on the high-fat meal model, as it was all that was available. There's new information that suggests that this may be incorrect. In either case, a substantial meal is important to absorption.