Zyprexa vs Geodon

[emergentmd]

Our facility have been using IM Geodon forever and seems to do well. Our sister hospitals and our SW is pushing to switch to Zyprexa as its less "activating". I assume this means that some get more "crazy" with Geodon.

Anyone have much insight on this?

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[Rendar5]

$$$$$$$?

 

[dotcb]

I've always kept it old school with vitamin D or H.

 

[EM2BE]

The receptors causing side effects may have a lot to do with it.


One will be more serotonergic, the other will have more histamine effects.

 

[atpsynthase]

Ziprasadone can also prolong the QT interval... the increased H1 receptor activity would describe the "less activating" side effects of olanzapine

I tend to think of ziprasadone as a good atypical for chronic use in patients who also have diabetes/morbid obesity and olanzapine as a good acute, slightly sedating option for ED administration

 

[demor]

Olanzapine has a broader receptor spectrum, probably more sedating than ziprasidone, and absolutely more weight increasing (if ziprasidone has weight increase as side effect at all).

 

[Carboxide]

Geodon interacts with...well, I guess the best term here is 'everything.' That's one big bonus to switching. Zyprexa only really influences stuff through CYP1A2, which is rarely relevent. Just a thought as well.

 

[K31]

Geodon interacts with...well, I guess the best term here is 'everything.' That's one big bonus to switching. Zyprexa only really influences stuff through CYP1A2, which is rarely relevent. Just a thought as well.

In my experience, a reason psychiatrists don't like Zyprexa is that you aren't supposed to combine it with benzos due to the risk of oversedation and respiratory depression. If Zyprexa doesn't calm them down enough, you don't have your usual second-line drug to go to.

 

[Apollyon]

Olanzapine has a broader receptor spectrum, probably more sedating than ziprasidone, and absolutely more weight increasing (if ziprasidone has weight increase as side effect at all).

And the relevance of that in the ED is exactly zero.

 

[atpsynthase]

In my experience, a reason psychiatrists don't like Zyprexa is that you aren't supposed to combine it with benzos due to the risk of oversedation and respiratory depression. If Zyprexa doesn't calm them down enough, you don't have your usual second-line drug to go to.

In my experience, you can give lorazepam AFTER IM olanzapine administration as long as its at least an hour afterward... and typically I see haloperidol still given first line before olanzapine.

 

[Rendar5]

In my experience, you can give lorazepam AFTER IM olanzapine administration as long as its at least an hour afterward... and typically I see haloperidol still given first line before olanzapine.

You don't normally have an hour to deal with a violent individual who is requiring 6 people to hold him down. That said I have never really needed anything other than haldol and ativan. sometimes you just need a ****load of the former 😉