From the Guidelines
Geodon (ziprasidone) is contraindicated in patients with sinus bradycardia due to its potential to prolong the QT interval and increase the risk of torsades de pointes. This antipsychotic medication should not be used in individuals with a history of significant bradycardia (abnormally slow heart rate) because it can worsen bradycardia and increase arrhythmia risk 1. The medication works by blocking dopamine and serotonin receptors to treat conditions like schizophrenia and bipolar disorder, but its effects on cardiac ion channels can lead to dangerous heart rhythm disturbances. Before prescribing Geodon, clinicians should perform baseline ECG testing and avoid its use in patients with bradycardia, history of QT prolongation, recent myocardial infarction, uncompensated heart failure, or in those taking other medications known to prolong the QT interval 1.
Key Considerations
- Geodon can prolong the QT interval, increasing the risk of torsades de pointes in patients with sinus bradycardia
- Patients with pre-existing bradycardia are at higher risk for cardiac complications when taking Geodon
- Alternative antipsychotics with less impact on cardiac conduction may be safer options for patients with bradycardia
- Baseline ECG testing is recommended before prescribing Geodon to patients with bradycardia or other cardiac conditions
Clinical Implications
- Clinicians should exercise caution when prescribing Geodon to patients with sinus bradycardia or other cardiac conditions
- Patients with bradycardia should be closely monitored for signs of cardiac complications, such as torsades de pointes, while taking Geodon
- Alternative treatment options should be considered for patients with bradycardia or other cardiac conditions who require antipsychotic medication 1.
From the FDA Drug Label
QT Interval Prolongation: Ziprasidone use should be avoided in patients with bradycardia, hypokalemia or hypomagnesemia, congenital prolongation of the QT interval, or in combination with other drugs that have demonstrated QT prolongation. ( 5. 3)
Geodon (ziprasidone) is contraindicated in patients with bradycardia, including sinus bradycardia, as its use should be avoided in such patients due to the risk of QT interval prolongation 2.
From the Research
Geodon (Ziprasidone) and Sinus Bradycardia
- There is no direct evidence in the provided studies that Geodon (ziprasidone) is contraindicated in sinus bradycardia 3, 4, 5, 6, 7.
- The studies focus on the clinical significance and management of bradyarrhythmias, including sinus bradycardia, and do not mention Geodon (ziprasidone) as a contraindicated medication.
- However, it is worth noting that some medications can exacerbate bradycardia, and mesalamine has been reported to cause severe symptomatic sinus bradycardia in a patient with a history of conduction tissue disease 5.
- The management of bradycardias typically involves the treatment of underlying causes, and pacemaker implantation may be indicated in certain cases, such as symptomatic bradycardias or third-degree AV block 4, 6.
- The evaluation of asymptomatic sinus bradycardia may involve the use of atropine and isoproterenol tests to assess chronotropic reserve 7.