Additional signs may include elevated creatinine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. The following adverse reactions have been identified during post-approval use of GEODON. A second widely used assessment, the Clinical Global Impression (CGI), reflects the impression of a skilled observer, fully familiar with the manifestations of schizophrenia, about the overall clinical state of the patient. Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue. Of the total number of subjects in clinical studies of ziprasidone, 2.4 percent were 65 and over. Severe cutaneous adverse reactions are sometimes fatal. Can you mix geodon and lorazepam in the same syringe? Somnolence was a commonly reported adverse reaction in patients treated with ziprasidone. Each mL of reconstituted solution contains 20 mg ziprasidone. This minimal amount of contact and mixing may allow 2 meds that really aren't terribly compatible to be given together because . In a 4-week, placebo-controlled trial (n=200) comparing 3 fixed doses of ziprasidone (5, 20, and 40 mg twice daily), none of the dose groups was statistically superior to placebo on any outcome of interest. Offspring developmental delays (decreased pup weights) and neurobehavioral functional impairment (eye opening air righting) were observed at doses of 5 mg/kg/day (0.2 times the MRHD based on mg/m2 body surface area) or greater. Titration within the range of 4080 mg twice daily (in 20 mg twice daily increments) was permitted for the duration of study (beginning on Day 2). 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. Rats exposed to ziprasidone during gestation and lactation exhibited increased perinatal pup mortality and delayed neurobehavioral and functional development of offspring at doses less than or similar to human therapeutic doses (see Data). If circumstances are so compelling as to warrant mixing any In the patient taking the largest confirmed amount, 3,240 mg, the only symptoms reported were minimal sedation, slurring of speech, and transitory hypertension (200/95). Mixing the two could lead to serious side effects such as drowsiness, impaired motor skills, and even respiratory depression. In the tables showing categorical changes, the percentages (% column) are calculated as 100(n/N). GEODON for Injection is available in a single-dose vial as ziprasidone mesylate (20 mg ziprasidone/mL when reconstituted according to label instructions) [see Dosage and Administration (2.1)]. The absorption of ziprasidone is increased up to two-fold in the presence of food. The pharmacokinetics of ziprasidone following 8 days of 20 mg twice daily dosing were similar among subjects with varying degrees of renal impairment (n=27), and subjects with normal renal function, indicating that dosage adjustment based upon the degree of renal impairment is not required. (ziprasidone mesylate), NDC 0049-1203-10 Depressive, manic, and mixed episodes accounted for 53%, 34%, and 13%, respectively, of the total number of relapse events in the study. PREMIERProRx is a registered trademark of Premier Healthcare Alliance, L.P., used under license. Weight gain has been observed with atypical antipsychotic use. The mean increase in QTc from baseline for ziprasidone was 4.6 msec following the first injection and 12.8 msec following the second injection. Steady-state concentrations are achieved within one to three days of dosing. Adverse reactions during exposure were obtained by collecting voluntarily reported adverse experiences, as well as results of physical examinations, vital signs, weights, laboratory analyses, ECGs, and results of ophthalmologic examinations. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. The stated frequencies of adverse reactions represent the proportion of individuals who experienced, at least once, a treatment-emergent adverse reaction of the type listed. Ativan is oily and hard to draw up by itself but by instilling the Haldol it causes it to draw up much easier! In the schizophrenia trials, ziprasidone was associated with a mean increase in heart rate of 1.4 beats per minute compared to a 0.2 beats per minute decrease among placebo patients. Given these considerations, ziprasidone should be prescribed in a manner that is most likely to minimize the occurrence of tardive dyskinesia. Ziprasidone should not be used with any drug that prolongs the QT interval [see Contraindications (4.1)]. Ziprasidone should be used with particular caution in patients with known cardiovascular disease (history of myocardial infarction or ischemic heart disease, heart failure or conduction abnormalities), cerebrovascular disease, or conditions which would predispose patients to hypotension (dehydration, hypovolemia, and treatment with antihypertensive medications). In a second 3-week placebo-controlled trial (n=205), the dose of ziprasidone was 40 mg twice daily on Day 1. Mixing is best avoided. There is no known treatment for established cases of tardive dyskinesia, although the syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn. GEODON for Injection is available in a single-dose vial as ziprasidone mesylate (20 mg ziprasidone/mL when reconstituted according to label instructions) [see Dosage and Administration (2.1)]. Objectively collected data from those trials on the Simpson-Angus Rating Scale (for EPS) and the Barnes Akathisia Scale (for akathisia) did not generally show a difference between ziprasidone and placebo. Ziprasidone was tested in the Ames bacterial mutation assay, the in vitro mammalian cell gene mutation mouse lymphoma assay, the in vitro chromosomal aberration assay in human lymphocytes, and the in vivo chromosomal aberration assay in mouse bone marrow. The developmental no-effect dose is 5 mg/kg/day (0.2 times the MRHD based on mg/m2 body surface area). Reconstitution of vial: Using aseptic technique, add 1.2 mL of Sterile Water for Injection, USP to the single-dose vial and shake vigorously until all the drug is dissolved. Most patients improved promptly with adjunctive treatment with antihistamines or steroids and/or upon discontinuation of ziprasidone, and all patients experiencing these reactions were reported to recover completely. Cardiovascular monitoring should commence immediately and should include continuous electrocardiographic monitoring to detect possible arrhythmias. Undesirable alterations in lipids have been observed in patients treated with atypical antipsychotics. Explorations for interactions on the basis of gender did not reveal any clinically meaningful differences in the adverse reaction occurrence on the basis of this demographic factor. Although the prevalence of the syndrome appears to be highest among the elderly, especially elderly women, it is impossible to rely upon prevalence estimates to predict, at the inception of antipsychotic treatment, which patients are likely to develop the syndrome. Esophageal dysmotility and aspiration have been associated with antipsychotic drug use. This effect may be greater when higher doses of carbamazepine are administered. When taking any two medications, consider this in addition to the fact that they have different mechanisms of action. Such drugs should not be prescribed with ziprasidone. As with other antipsychotic drugs and placebo, sudden unexplained deaths have been reported in patients taking ziprasidone at recommended doses. In patients who do require chronic treatment, the smallest dose and the shortest duration of treatment producing a satisfactory clinical response should be sought. treatment of akathesia is pretty straight forward. During long-term therapy with ziprasidone, a categorization of patients at baseline on the basis of body mass index (BMI) revealed the greatest mean weight gain and highest incidence of clinically significant weight gain (> 7% of body weight) in patients with low BMI (<23) compared to normal (2327) or overweight patients (>27). Advise patients that GEODON may cause extrapyramidal and/or withdrawal symptoms (agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorder) in a neonate. Ziprasidone should be discontinued in patients who are found to have persistent QTc measurements >500 msec. The standard dose of the combination used for chemical sedation of the agitated patient is "ten and two" meaning 10mg of Haldol and 2mg of Ativan. As ziprasidone is cleared substantially by the liver, the presence of hepatic impairment would be expected to increase the AUC of ziprasidone; a multiple-dose study at 20 mg twice daily for 5 days in subjects (n=13) with clinically significant (Childs-Pugh Class A and B) cirrhosis revealed an increase in AUC 012 of 13% and 34% in Childs-Pugh Class A and B, respectively, compared to a matched control group (n=14). Hypokalemia may result from diuretic therapy, diarrhea, and other causes. Nevertheless, the presence of multiple factors that might increase the pharmacodynamic response to ziprasidone, or cause poorer tolerance or orthostasis, should lead to consideration of a lower starting dose, slower titration, and careful monitoring during the initial dosing period for some elderly patients. Over 325 of these subjects participated in trials involving the administration of multiple doses. There's just seldom a decent reason to do so. Although 80 mg twice daily had a numerically greater effect than 40 mg twice daily, the difference was not statistically significant. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. You can mix them, yes. Rare adverse reactions occurring in fewer than 1/1000 patients (<0.1% of patients). Symptoms of schizophrenia include: Although there are no reports of adverse effects on a breastfed infant exposed to ziprasidone via breast milk, there are reports of excess sedation, irritability, poor feeding, and extrapyramidal symptoms (tremors and abnormal muscle movements) in infants exposed to other atypical antipsychotics through breast milk (see Clinical Considerations). The Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS) are both multi-item inventories of general psychopathology usually used to evaluate the effects of drug treatment in schizophrenia. Common interactions include weight increased among females and dyspnoea among males. A total of 584 subjects were treated in the open-label stabilization period. The need for continued treatment should be reassessed periodically. Division of Pfizer Inc chlorproMAZINE LORazepam. An additive effect of ziprasidone and other drugs that prolong the QT interval cannot be excluded. 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