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Q: Withdrawing from Geodon
I am a 58 year old bipolar II with a lot of rapid cycling. I have been taking lamotrogene and geodon for 4 years, I have recently weened myself
from lexapro, and my symptons, especially depression, have improved markedly. I
would like to consider reducing my geodon doses, but I can find no information
about withdrawal from this drug. I have the teeth clenching and facial ticks
associated with Geodon and I would like to get myself to the point that I use
lamotrogene only. My psychiatrist is on board with these changes, but she has no
information on withdrawal.
Thanks
Dear T’ --
Thank you for noting that your psychiatrist is on board with the changes. That
is crucial.
Ziprasidone (Geodon) is not a medication with which I have tapering experience
So far, either my patients have either done poorly on it, and stopped it quickly
with little or no taper, or done well on it and continued it (unfortunately,
rather few in the latter group). So my minimal comment here is based on theory,
not experience. And, like your psychiatrist, I'm not aware of a literature on
this.
Interestingly, searching ziprasidone taper on Google, there is one
published comment, in a Medscape article (there is nothing in the National
Library of Medicine via PUB MED). Someone wrote asking:
I
have encountered severe withdrawal effects when discontinuing ziprasidone HCI (Geodon),
even with a very slow taper of the drug. I'm wondering whether others have seen
this in their patients.
The reply,
by a Wyoming nurse practitioner, speaks in general terms about "antipsychotic
withdrawal syndrome but not about ziprasidone specifically. (You might be able
to read the article, if Medscape will let you register. Here is
the link. If not, your psychiatrist can probably get it if she is
registered, which should be free. But the article is not terribly helpful, in
my opinion, so don’t sweat getting it).
The
problem is, ziprasidone is recognized to have a very unusual pattern of
activity. At low doses, it seems to act more like an antidepressant. The cut
off for this phenomenon is somewhere around 80 mg per day. Most practitioners
seem to think that 120 mg is above that threshold. Since antidepressants can
make bipolar disorder or worse, and I've certainly seen the low doses of
ziprasidone make things worse, in theory, when tapering it off, the idea would
be to get down to 120 mg and then probably stop from there. Otherwise you might
have an antidepressant on board rather suddenly. Remember, that is all theory.
As may
have already occurred, you might talk with your psychiatrist about being
prepared to use something like olanzapine (Zyprexa) on an as-needed basis,
temporarily (hopefully less than a week, thereby avoiding the weight gain that
can develop quite quickly with olanzapine). You might need to have something
powerful (and very roughly akin to ziprasidone, but easily stopped or tapered)
to smooth out any bumps which emerge. Hopefully that should be a relatively
short bumpy phase, as I’ve not found descriptions of a prolonged withdrawal
phase (which one might think would have appeared in the literature should that
be a common problem).
Good luck
with the process --
Dr. Phelps
Published April, 2009
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