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

Most common
somnolence (up to 52%)
akathisia (up to 27%)
dizziness (up to 18%)
weight gain (1-10%)

Geodon

Most common
extrapyramidal symptoms (up to 31%)
somnolence (14-20%)
headache (13-18%)
nausea (up to 12%)

Zyprexa vs. Geodon Dosage

Zyprexa

Dosage
Dosage Table
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

Dosage
Dosage Table
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

Common Symptoms and Related Diseases You Can Explore

Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.