Are Higher Starting Doses of Geodon Better for Bipolar Patients?

Dosage guidelines for new pharmaceutical products are typically based on strictly controlled clinical trials that may not represent every possible patient or situation. In practice, physicians often find that dosages must be raised or lowered to achieve ideal efficacy. Geodon (ziprasidone), an atypical antipsychotic, is one such example of a psychotropic medication for which recommended dosing and real-world practice do not always agree. The use of Geodon with schizophrenia patients is well documented, and dose levels are equally well understood. With bipolar disorder, however, the picture is not as clear. Best practices for prescribing Geodon to individuals with bipolar are still being determined.

Several studies have proven that Geodon brings about significant and remarkable rapid improvement in manic or psychotic symptoms of bipolar. The current clinical guidelines suggest beginning with a daily dose of 80 mg, then stepping up to a dose ranging from 120 to 160 mg. There is compelling evidence, however, that initializing treatment with a high dose of Geodon, rather than the “step up” approach, leads to better outcomes and a greater likelihood that the individual will stay the course. As with many psychiatric disorders, patients with bipolar often neglect to stick with their medications. When symptoms can be improved more rapidly, patients have immediate motivation to follow their prescriptions more strictly.

A study in Korea assessed the response of individuals with bipolar to varying dosages of Geodon over a 6-week period. Some individuals were started at a low dose and then stepped up, while others began treatment at the higher dosage. The results demonstrated that patients who began with the higher dosage had better remission of bipolar manic symptoms and scored better at the end of treatment on a variety of psychological wellness tests. Furthermore, there was no significant difference between the groups in terms of side effects or withdrawal from the study. These results strongly suggest that there is no benefit to beginning treatment at a lower dose, despite recommendations from the drug maker.

Geodon belongs to the class of atypical antipsychotics, but its activity on the neurochemical level is unique among its peers. Because of its unique properties, Geodon is effective in the treatment of a variety of mental illnesses, and it is considered relatively safe and well tolerated. The drug’s usefulness in treating bipolar is still somewhat unknown. Research in Korea and elsewhere, however, has shown that starting individuals with bipolar who are experiencing manic symptoms on a relatively high dose of Geodon is a feasible first-line treatment.


  1. Woo, Y. S., Bahk, W., Jo, S. H., Yoon, B., Lee, J. G., Kim, W., et al. (2011). Effect of initial ziprasidone dose on treatment outcome of Korean patients with acute manic or mixed episodes. Psychiatry Investigation, 8, 207-213.
  2. PubMed Health. [Internet]. (n.d.). Bethesda (MD): National Library of MedicineZiprasidone. Retrieved March 10, 2012. Available from:


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