| Bipolar I disorder
Geodon vs Igalmi
Side-by-side clinical, coverage, and cost comparison for bipolar i disorder.Deep comparison between: Geodon vs Igalmi with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsIgalmi has a higher rate of injection site reactions vs Geodon based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Igalmi but not Geodon, including UnitedHealthcare
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Category
Geodon
Igalmi
At A Glance
Oral / IM injection
Twice daily
D2/5HT2 antagonist
Sublingual or buccal film
As needed (acute use)
Alpha-2 adrenergic receptor agonist
Indications
- Schizophrenia
- Bipolar I disorder
- Schizophrenia
- Bipolar I disorder
- Bipolar Disorder Type 2
Dosing
Schizophrenia Initiate at 20 mg twice daily with food; may adjust up to 80 mg twice daily at intervals of not less than 2 days.
Schizophrenia (acute agitation, IM) 10-20 mg IM as needed up to 40 mg/day; 10 mg may be given every 2 hours, 20 mg every 4 hours; limit to 3 consecutive days, then transition to oral.
Bipolar I disorder (acute manic/mixed episodes) Initiate at 40 mg twice daily with food; increase to 60 or 80 mg twice daily on day 2; subsequent doses adjusted within 40-80 mg twice daily range based on tolerability and efficacy.
Bipolar I disorder (maintenance, adjunct to lithium or valproate) Continue at the same dose on which the patient was initially stabilized, within the range of 40-80 mg twice daily with food.
Schizophrenia, Bipolar I disorder, Bipolar Disorder Type 2 - Adults Mild or moderate agitation: 120 mcg initial dose SL or buccal; severe agitation: 180 mcg initial; up to 2 additional doses (60-90 mcg) at least 2 hours apart; maximum 240-360 mcg/day.
Mild or Moderate Hepatic Impairment Mild or moderate agitation: 90 mcg initial; severe agitation: 120 mcg initial; optional additional doses of 60 mcg at least 2 hours apart; maximum 210-240 mcg/day.
Severe Hepatic Impairment Mild or moderate agitation: 60 mcg initial; severe agitation: 90 mcg initial; optional additional doses of 60 mcg at least 2 hours apart; maximum 180-210 mcg/day.
Geriatric Patients (>=65 years) 120 mcg initial dose regardless of agitation severity; optional additional doses of 60 mcg at least 2 hours apart; maximum 240 mcg/day.
Contraindications
- Known history of QT prolongation, including congenital long QT syndrome
- Recent acute myocardial infarction
- Uncompensated heart failure
- Concomitant use with drugs that prolong the QT interval (e.g., dofetilide, sotalol, quinidine, Class Ia and III anti-arrhythmics, mesoridazine, thioridazine, chlorpromazine, droperidol, pimozide, sparfloxacin, gatifloxacin, moxifloxacin, halofantrine, mefloquine, pentamidine, arsenic trioxide, levomethadyl acetate, dolasetron mesylate, probucol, tacrolimus)
- Known hypersensitivity to ziprasidone or any excipient
- Concomitant use of MAOIs, or use within 14 days of stopping an MAOI
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Adverse Reactions
Most common (>=5%) Somnolence, extrapyramidal symptoms, akathisia, dizziness, nausea, constipation, respiratory tract infection, headache, asthenia, abnormal vision
Serious QT prolongation, neuroleptic malignant syndrome, serotonin syndrome, tardive dyskinesia, DRESS, leukopenia, neutropenia, agranulocytosis, seizures
Postmarketing Torsade de pointes, facial droop, galactorrhea, priapism, somnambulism, angioedema, urinary incontinence, postural hypotension, syncope
Most common (>=5%) Somnolence, oral paresthesia or oral hypoesthesia, dizziness, dry mouth, hypotension, orthostatic hypotension.
Serious Hypotension, orthostatic hypotension, bradycardia, QT interval prolongation, somnolence, withdrawal reactions, tolerance and tachyphylaxis.
Postmarketing Arrhythmia, atrial fibrillation, cardiac arrest, bradycardia, convulsion, apnea, bronchospasm, agitation, delirium, hallucination, hypertension, rash, urticaria.
Pharmacology
Ziprasidone is a dopamine D2/D3 and serotonin 5HT2A/5HT2C antagonist with agonist activity at 5HT1A receptors and inhibition of synaptic reuptake of serotonin and norepinephrine; its antipsychotic and antimanic effects are thought to be mediated through combined D2 and 5HT2 antagonism.
Dexmedetomidine is an alpha-2 adrenergic receptor agonist whose mechanism of action in acute agitation is thought to involve activation of presynaptic alpha-2 adrenergic receptors; it also exhibits concentration-dependent QT prolongation.
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Most Common Insurance
Anthem BCBS
Geodon
- Covered on 5 commercial plans
- PA (6/12) · Step Therapy (6/12) · Qty limit (0/12)
Igalmi
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (1/12) · Qty limit (11/12)
UnitedHealthcare
Geodon
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Igalmi
- Covered on 4 commercial plans
- PA (2/8) · Step Therapy (1/8) · Qty limit (0/8)
Humana
Geodon
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (1/3)
Igalmi
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (1/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Geodon.
No savings programs available for Igalmi.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.