Zyprexa vs. Geodon
See how Zyprexa and Geodon compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Zyprexa and Geodon are both atypical antipsychotics for schizophrenia and bipolar disorder, but Zyprexa has broader FDA approval that includes bipolar depression and treatment-resistant depression when combined with fluoxetine.
Zyprexa carries a higher risk of weight gain and sedation, while Geodon carries a boxed warning for QT interval prolongation and must be taken with a substantial meal to absorb properly.
Both drugs carry a boxed warning for increased mortality in elderly patients with dementia-related psychosis, and neither is approved for that use.
Zyprexa vs. Geodon Drug Summary
Zyprexa
Zyprexa (olanzapine) is an atypical antipsychotic used to treat schizophrenia and bipolar I disorder, including acute mania and long-term maintenance. It comes as an oral tablet, an orally disintegrating tablet, a short-acting injection, and a long-acting monthly injection (Relprevv) for ongoing treatment.
Geodon
Geodon (ziprasidone) is an atypical antipsychotic used to treat schizophrenia and bipolar manic or mixed episodes, either alone or alongside lithium or valproate. It comes as an oral capsule taken with food, and a short-acting intramuscular injection is available for acute agitation.
Zyprexa vs. Geodon Side Effects
Zyprexa
Geodon
Zyprexa vs. Geodon Dosage
Zyprexa
Geodon
| STAGE | DOSE | WHEN |
| Starting dose | 5-10 mg once daily | At the start |
| Maximum dose | 2.5-10 mg per IM dose | If needed |
| Dose changes | 4 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg twice daily | At the start |
| Maximum dose | 20-80 mg twice daily | If needed |
| Dose changes | 1 increase | As tolerated |
Zyprexa
| STAGE | DOSE | WHEN |
| Starting dose | 5-10 mg once daily | At the start |
| Maximum dose | 2.5-10 mg per IM dose | If needed |
| Dose changes | 4 increases | As tolerated |
Geodon
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg twice daily | At the start |
| Maximum dose | 20-80 mg twice daily | If needed |
| Dose changes | 1 increase | As tolerated |
Zyprexa vs. Geodon Indications
Zyprexa
Zyprexa is FDA-approved for schizophrenia in adults and adolescents, bipolar I mania alone or with lithium or valproate, and maintenance bipolar treatment. It is also approved with fluoxetine for bipolar depression and treatment-resistant depression, and it is sometimes used off-label for chemotherapy-related nausea.
Schizophrenia in adults and adolescents (13-17)
Bipolar I mania, alone or with lithium/valproate
Maintenance treatment of bipolar I disorder
Acute agitation in schizophrenia or bipolar mania
Geodon
Geodon is FDA-approved for schizophrenia in adults and for acute bipolar manic or mixed episodes as monotherapy. It is also approved as an add-on to lithium or valproate for maintenance bipolar treatment, and its injectable form is approved for acute agitation in schizophrenia.
Schizophrenia in adults
Acute bipolar manic or mixed episodes
Maintenance bipolar disorder, adjunct therapy
Acute agitation in schizophrenia (IM form)
Zyprexa vs. Geodon Pros and Cons
Zyprexa
Zyprexa has one of the broadest FDA approval profiles among atypical antipsychotics, covering both manic and depressive phases of bipolar disorder. It carries a real risk of weight gain and sedation that calls for ongoing monitoring, and its long-acting injectable form requires supervised observation after each dose. It typically costs less out of pocket than Geodon.
Pros
Approved for a wider range of uses, including bipolar depression with fluoxetine
Available as a long-acting monthly injection (Relprevv) for maintenance therapy
No boxed warning for QT prolongation, so less cardiac monitoring is typically needed
Cons
Higher risk of significant weight gain and metabolic changes over time
Relprevv requires a mandatory 3-hour in-office observation after each injection
Somnolence is very common, affecting up to half of patients
Geodon
Geodon is associated with less weight gain than many other atypical antipsychotics, which can matter for patients managing metabolic health. Its main tradeoff is a boxed warning for QT interval prolongation, along with a strict requirement to take it with a substantial meal for proper absorption. It typically costs more out of pocket than Zyprexa.
Pros
Associated with less weight gain than many other atypical antipsychotics
Lower rates of sedation, with somnolence affecting up to 20% of patients
Straightforward twice-daily oral dosing without a multi-week titration schedule
Cons
Boxed warning for QT interval prolongation, requiring caution with heart conditions
Must be taken with a meal of at least 500 calories to absorb properly
Higher risk of extrapyramidal symptoms, reported in up to 31% of patients
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