Long (long) time readers will recall that once-upon-a-time I took the atypical antipsychotic Geodon. I found this to be an unbearably painful and side effect laden psych med. I hated Geodon. I wouldn’t wish Geodon on my worst enemy. I lost touch with reality on Geodon. I passed out at work on Geodon. I got sick constantly on Geodon.

You know, that being said, Geodon works for a lot of people.

I gather my reaction to this antipsychotic was fairly atypical. And if I had known what to eat when taking Geodon that might have helped.

About Geodon

Geodon (generic ziprasidone, also marketed as Zeldox by Pfizer) was the fifth atypical antipsychotic to receive FDA approval, in 2001. Geodon is approved to treat schizophrenia, bipolar disorder mixed-states and bipolar mania. And, of course, Geodon is prescribed off label in other cases of bipolar disorder or for depression.[1]

Facts about the Atypical Antipsychotic Geodon

Interesting facts about atypical antipsychotic Geodon:

Has a very short half-life – a mean of 2-5 hours

Geodon should always be taken with food (see below)

It slightly increases the QTc interval (heart rhythm)

Geodon can occasionally cause mania in people with bipolar disorder

It has all the other nasty effects that atypical antipsychotics do like weight gain, diabetes, tardive dyskinesia and the like.

Geodon Must be Taken with Food

One of the nasty problems I had with Geodon is that I found unless I ate exactly the right thing (red meat, I found, but results were variable) I would get really sick after taking the drug. I would feel nauseated, dizzy, crazy and basically so sick I had to go to sleep. And it was really hard to predict exactly when this would happen. It was a bitch.

Food with Geodon Affects Bioavailability

What I didn’t know is what really matters is the number of calories consumed with Geodon.

I had thought taking the Geodon was making me sick but actually it was the withdrawal from Geodon making me sick. Due to the short half-life, if I didn’t get the correct dose of Geodon, I went through withdrawal. (I took it once a day, increasing the problem.)

And as it turns out, if you don’t eat the right food, Geodon isn’t properly absorbed into your bloodstream. This is known as bioavailability. If you take Geodon without food its bioavailability may only be 50%. So 200mg becomes 100mg.

What to Eat with Geodon

While psychiatrists generally tell people to take Geodon with food, I doubt anyone mentions that if you don’t, it is only half as useful.

Luckily, there’s a study.[2] According to The impact of calories and fat content of meals on oral Ziprasidone [Geodon] absorption: a randomized, open-label, crossover trial:

Maximum Geodon absorption was seen with meals of 1000 calories

Low-calorie meals of 250 calories had only a 60% – 90% absorption rate, highly variable

Meals of 500 calories were close to the absorption rate of the 1000 calorie meals

Meals of 500 – 1000 calories had much less variable Geodon absorption rates

Fat content of the meal had no bearing on outcome

So, in short, if you’re taking Geodon, you should eat a meal of 500 calories or more when you take your Geodon.[3]

Isn’t That a Lot of Calories?

I’d say so, yes. Seeing as dosage instructions for Geodon are to take Geodon twice daily with food, that’s at least 1000 calories right there. Kind of nutty, but there it is.

Do Doctors Know about Calories, Diet and Geodon?

Honestly, I have no idea. I wouldn’t be surprised if they didn’t know the magic formula was 500 calorie meals with Geodon. You might want to ask your doctor about it.

More on diet and bipolar disorder over on Breaking Bipolar.

[1] In case you’re curious, Geodon is one of four drugs Pfizer plead guilty to illegally promoting for disorders for which it was not FDA approved.

[2] By the way, you could get around this problem with intramuscular injections. If, you know, that were an option for you.

[3] And by “should” I mean according to the study and after talking to your doctor. Of course.