What is the comparison between Ziprasidone (Geodon) and Quetiapine (Seroquel)?

From the Guidelines

Geodon (ziprasidone) is generally preferred over Seroquel (quetiapine) due to its more favorable side effect profile, particularly with regards to metabolic effects such as weight gain and diabetes risk. Both medications are atypical antipsychotics used to treat conditions like schizophrenia, bipolar disorder, and sometimes as adjuncts for depression or anxiety. They work by blocking dopamine and serotonin receptors in the brain, but have different potencies and side effect profiles. According to a study published in 2017 1, ziprasidone and lurasidone appear to be the most weight-neutral options among antipsychotics, with aripiprazole also demonstrating a lower risk for weight gain. In contrast, quetiapine is consistently associated with weight gain, along with other medications like olanzapine and risperidone.

Some key differences between Geodon and Seroquel include:

• Dosing: Geodon typically requires twice-daily dosing with food, while Seroquel is available in immediate and extended-release formulations and can be dosed once daily.
• Sedation: Seroquel is often more sedating, making it useful for patients with insomnia or agitation.
• Metabolic effects: Geodon tends to have less metabolic side effects, such as weight gain and diabetes risk, compared to Seroquel.
• Cardiac effects: Both medications require monitoring for cardiac effects, particularly QT prolongation, although Geodon may have a higher risk of QT prolongation compared to Seroquel, with a mean QT prolongation of 5-22ms 2.

When choosing between Geodon and Seroquel, it is essential to consider the specific symptoms being targeted, side effect concerns, and patient-specific factors like medication history and comorbidities. Both medications require monitoring for side effects, including movement disorders, metabolic changes, and cardiac effects. Ultimately, the decision between Geodon and Seroquel should be based on a thorough evaluation of the patient's individual needs and medical history.

From the FDA Drug Label

A study directly comparing the QT/QTc prolonging effect of oral ziprasidone with several other drugs effective in the treatment of schizophrenia was conducted in patient volunteers. ... The mean increase in QTc from baseline for ziprasidone ranged from approximately 9 to 14 msec greater than for four of the comparator drugs (risperidone, olanzapine, quetiapine, and haloperidol)

The comparison between Ziprasidone (Geodon) and Quetiapine (Seroquel) is that ziprasidone has a greater QTc prolongation effect, with a mean increase in QTc from baseline ranging from approximately 9 to 14 msec greater than quetiapine 3.

From the Research

Comparison of Ziprasidone and Quetiapine

• Ziprasidone (Geodon) and Quetiapine (Seroquel) are both atypical antipsychotics used in the treatment of schizophrenia and bipolar disorder 4, 5.
• Ziprasidone has been shown to have some limited clinical advantages over traditional antipsychotics, such as chlorpromazine and haloperidol, in ameliorating negative symptoms of schizophrenia 4.
• Quetiapine has been found to be effective in reducing manic symptoms in adult and adolescent patients with acute bipolar mania, and is also effective in reducing depressive symptoms in patients with bipolar depression 5, 6.
• In terms of tolerability, ziprasidone has been associated with a lower risk of weight gain, adverse changes in cholesterol and triglycerides, and glycemic control, compared to other atypical antipsychotics 4.
• Quetiapine has been found to have a low incidence of extrapyramidal symptom-related adverse events and low EPS ratings in bipolar disorder 5.
• A study comparing the effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia found that risperidone and olanzapine were more effective than quetiapine and ziprasidone, as reflected by longer time until discontinuation for any reason 7.

Efficacy in Specific Conditions

• Ziprasidone has been found to be efficacious in the treatment of acute agitation in patients with schizophrenia, with significant and rapid reduction in agitation and improvement in psychotic symptoms 8.
• Quetiapine has been found to be effective in the treatment of acute mania and depression associated with bipolar disorder, and is approved for use in adults for this indication 5, 6.
• Ziprasidone may be considered a first-line drug option in the treatment of schizophrenia or manic episodes, but drug selection should be guided by the patient's individual characteristics and situation 4.
• Quetiapine monotherapy should be considered a first-line option for the acute treatment of bipolar depression, despite the current lack of data from active comparator trials 6.

Tolerability and Safety

• Ziprasidone has been associated with a lower risk of adverse events, such as movement disorders, compared to traditional antipsychotics 4, 8.
• Quetiapine has been found to be generally well tolerated in bipolar depression, and is not associated with an increased risk of treatment-emergent mania 6.
• Ziprasidone may prolong the electrocardiogram (ECG) QTc interval, but this does not appear to pose a substantial clinical problem 4.
• Quetiapine has been found to have a low incidence of extrapyramidal symptom-related adverse events and low EPS ratings in bipolar disorder 5.