Tips for tapering off ziprasidone (Geodon, Zeldox)

[Altostrata]

ADMIN NOTE Also see Dose Equivalents for Second-Generation Antipsychotics

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AKA Geodon, Zeldox, Zipwell
 
Ziprasidone is an antipsychotic or neuroleptic in the same drug class as risperidone (Risperdal) or quetiapine (Seroquel).
 
It has a host of side effects. See http://en.wikipedia.org/wiki/Ziprasidone for background.
 
http://www.drugs.com/pro/geodon.html

 

Quote

Geodon Capsules are supplied for oral administration in 20 mg (blue/white), 40 mg (blue/blue), 60 mg (white/white), and 80 mg (blue/white) capsules.

 
Because of its short half-life, Geodon is usually taken twice a day.

 

Generic versions of the capsules, which would be quite a bit cheaper than name-brand Geodon,  are available.
 
http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=60854
Capsule half-life:

Quote

Elimination of ziprasidone is mainly via hepatic metabolism with a mean terminal half-life of about 7 hours within the proposed clinical dose range.

 
About the injection http://www.drugs.com/pro/geodon.html :
 

Quote

....The recommended dose is 10 mg to 20 mg administered as required up to a maximum dose of 40 mg per day. Doses of 10 mg may be administered every two hours; doses of 20 mg may be administered every four hours up to a maximum of 40 mg/day. Intramuscular administration of ziprasidone for more than three consecutive days has not been studied.
 
If long-term therapy is indicated, oral ziprasidone hydrochloride capsules should replace the intramuscular administration as soon as possible.
 
Since there is no experience regarding the safety of administering ziprasidone intramuscular to schizophrenic patients already taking oral ziprasidone, the practice of co-administration is not recommended....

 

Very careful tapering is necessary when you have had psychotic symptoms. Withdrawal symptoms that look like psychosis can appear even in those who never had psychosis. If you have a prior diagnosis of psychosis, emergence of these symptoms from dopamine supersensitivity can cause you to become diagnosed as "relapsed" and re-medicated. Read Psychiatrist: Some patients are better off without antipsychotics...

Reduce by 10% per month to start
The 10% rule holds for ziprasidone just like other psychiatric drugs: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)

See Why taper by 10% of my dosage?

 

 

 

Using Geodon liquid to taper

Using a liquid to taper is the easiest way to accurately reduce dosage by small amounts.

 

Brand-name Geodon (ziprasidone) oral suspension (liquid) is available
http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021483s003lbl.pdf
 

Quote

GEODON Oral Suspension is supplied for oral administration as ziprasidone 10 mg/mL in 60 mL (600 mg) [order code NDC 0049-4030-32] and 240 mL (2400 mg) [order code NDC 0049-4030-92] bottles....Each mL contains 10 mg ziprasidone.

 

....GEODON Oral Suspension contains ziprasidone hydrochloride monohydrate, xylitol, citric acid, sodium citrate, sodium chloride, xanthan gum, colloidal silicon dioxide, methylparaben, propoylparaben, polysorbate 80, cherry flavor and water.
.....
Ziprasidone [the drug itself] is well absorbed after oral administration, reaching peak plasma concentrations in 6 to 8 hours.
....
GEODON Oral Suspension should be administered with food.
....
An oral dispenser (syringe-type) with a press-in bottle adapter is provided with the oral suspension. The oral dispenser for the 60 mL bottle is calibrated in 0.25 mL (2.5 mg) increments; the oral dispenser for the 240 mL bottle is calibrated in 1.0 mL (10 mg) increments....

 

Always check the concentration of the liquid you get and adjust your calculations accordingly.
 

You will need an oral syringe to measure out your dose of the liquid. Read this about oral syringes.

Also see http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__view__findpost__p__21391

Make your own liquid to taper
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018175/

Quote

....Currently, a liquid formulation of ziprasidone is prepared as a suspension using Geodon hydrochloride capsules (20–80 mg ziprasidone base each) or as a solution using Geodon mesylate injection (20 mg base/mL)....

[The researchers used the injectable solution for their experiment] For a flavored vehicle, we chose Ora-Sweet (Paddock Laboratories, Minneapolis, MN). This commercially available compounding agent is a transparent, alcohol-free, flavored oral syrup with a pale pink color and a pleasant taste. Its listed ingredients are purified water, sucrose, glycerin, sorbitol, flavoring, citric acid, sodium phosphate, methylparaben, and potassium sorbate.

....
The findings suggest that chemical and physical stability are maintained for 2 weeks under refrigeration, allowing the convenience of compounding for the long-term needs of a particular patient, rather than daily compounding. The only storage condition we recommend is refrigeration at 5°C.....

 

This accords with our other experience making do-it-yourself liquids with capsules and water. (Injectable Geodon is diluted with sterile water prior to injection.)

For more information about making a liquid from capsules and water or pharmaceutical bases such as Ora-Sweet, see http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/
 
Using a combination of tablets or capsules and liquid
Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.

 

For example, if you are taking 20mg ziprasidone twice a day, you could take the first part of your daily dosage in a 20mg capsule and the second 20mg in liquid form.
 
If your doctor prescribes liquid and tablets or capsules at the same time, most likely, he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance.

 

Divide up capsule contents with an electronic scale
If you do not want to use a liquid to taper, you might weigh the powder in a capsule with an electronic scale, divide it up, and put it into empty gelatin capsules to make up custom dosage amounts.

 

See Using a digital scale to measure doses

 

See more about using empty gelatin capsules at http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__p__3033#entry3033

Have a compounding pharmacy make up capsules of smaller dosages
A compounding pharmacy will accurately weigh the doses and put them into capsules for you. See http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__p__3001#entry3001

 

Tapering injectable ziprasidone

 

Injectable ziprasidone has a short half-life according to https://www.drugs.com/pro/geodon.html

 

Quote

After intramuscular administration of single doses, peak serum concentrations typically occur at approximately 60 minutes post-dose or earlier and the mean half-life (T½) ranges from two to five hours. Exposure increases in a dose-related manner and following three days of intramuscular dosing, little accumulation is observed.

 

Usually, people are given Geodon injections in the hospital and switched to tablets when they are released.

 

https://www.drugs.com/dosage/geodon-injection.html

 

Quote

 

Geodon Injection Dosage

....

Intramuscular Dosing

The recommended dose is 10 mg to 20 mg administered as required up to a maximum dose of 40 mg per day. Doses of 10 mg may be administered every two hours; doses of 20 mg may be administered every four hours up to a maximum of 40 mg/day. Intramuscular administration of ziprasidone for more than three consecutive days has not been studied.

 

If long-term therapy is indicated, oral ziprasidone hydrochloride capsules should replace the intramuscular administration as soon as possible.

 

Since there is no experience regarding the safety of administering ziprasidone intramuscular to schizophrenic patients already taking oral ziprasidone, the practice of co-administration is not recommended.

....

Intramuscular Preparation for Administration

GEODON for Injection (ziprasidone mesylate) should only be administered by intramuscular injection and should not be administered intravenously. Single-dose vials require reconstitution prior to administration.

 

Add 1.2 mL of Sterile Water for Injection to the vial and shake vigorously until all the drug is dissolved. Each mL of reconstituted solution contains 20 mg ziprasidone. To administer a 10 mg dose, draw up 0.5 mL of the reconstituted solution. To administer a 20 mg dose, draw up 1.0 mL of the reconstituted solution. Any unused portion should be discarded. ....

 

 

 

According to these instructions, the clinician could administer a 5mg Geodon injection by taking up 0.25mg of the solution, and so forth for other customized dosages.

 

Edited November 4, 2023 by Altostrata
updated

[Marsha]

Hi to all. I have a question which probably has an obvious answer but I don't know it. I have a new vial of geodon. I am reducing to 60 mgs in a little less than two weeks. The average weight of the 60 mg capsules is way less than the average weight of the 80 mg capsules. I know my calculations are correct. The average weight of the 80 mg capsules is 359 grams. I have made two reductions. I am at a little less than 300 grams by weight which is approximately 67 mgs. The weight of the 60 mg capsules is 219 grams. Why is there such a difference in the gram weight between the 80 mg capsules and the 60 mg capsules? Will I actually be reducing by 10% when I start taking the 60 mg capsules?

[Altostrata]

Marsha, it's always more helpful to think of your dosage as the amount of active ingredient (ziprasidone) in milligrams rather than the weight of capsule contents.

 

If you are taking 67mg ziprasidone now, when you take a 60mg capsule, you will be taking 60mg ziprasidone regardless of its weight.

 

The weight of the capsules includes inactive ingredients. The dosage strength (60mg or 80mg) is the amount of active ingredient (ziprasidone) in the capsule.

[Marsha]

Thank you Altostrata for the explanation. So when I'm ready to reduce from 60 mgs then I would get the average weight of several 60 mg capsules do the calculations to get the 10% and convert to milligrams then continue with the reduction process of the geodon/ ziprasidone.

[Altostrata]

There are two calculations: The average weight of the capsule contents in milligrams and the dosage of the active ingredient in milligrams. They are not the same.

 

If you multiply the average weight of a 60mg capsule by 90%, you will get the weight of the material you need to take for a 10% reduction.

 

That weight should equal 90% of the active ingredient in a 60mg capsule, or 54mg.

 

(Is the average weight of the 60 mg capsules 219 milligrams rather than 219 grams?)

[Marsha]

There are two calculations: The average weight of the capsule contents in milligrams and the dosage of the active ingredient in milligrams. They are not the same.

 

If you multiply the average weight of a 60mg capsule by 90%, you will get the weight of the material you need to take for a 10% reduction.

 

That weight should equal 90% of the active ingredient in a 60mg capsule, or 54mg.

 

(Is the average weight of the 60 mg capsules 219 milligrams rather than 219 grams?)

Hello Altostrata. I clearly do not understand what I am doing or how much ziprasidone I am taking in milligrams. This is what I did. I took the weight of 5 80 mg capsules which equaled 1796. Then I divided by 5 and got 359 (is this the average weight?) in grams? I wanted to take 67 mgs so I took 67/80 which was. .8375 I then multiplied 359 by .8375 and got 300. This 300 is the amount I am taking. Does this equal 67mgs? It reads on the scale .300 grams. I don't know what to do. (When I added the weights of the individual capsules I left off the decimal points at the beginning of the weights.) Did this mess things up? I am very confused. I don't know anything about math. I am using the Gemini 20 digital scale. I am so sorry. I don't want to be a burden. I just need so much help to figure this out.

[Marsha]

 

There are two calculations: The average weight of the capsule contents in milligrams and the dosage of the active ingredient in milligrams. They are not the same.

 

If you multiply the average weight of a 60mg capsule by 90%, you will get the weight of the material you need to take for a 10% reduction.

 

That weight should equal 90% of the active ingredient in a 60mg capsule, or 54mg.

 

(Is the average weight of the 60 mg capsules 219 milligrams rather than 219 grams?)

Hello Altostrata. I clearly do not understand what I am doing or how much ziprasidone I am taking in milligrams. This is what I did. I took the weight of 5 80 mg capsules which equaled 1796. Then I divided by 5 and got 359 (is this the average weight?) in grams? I wanted to take 67 mgs so I took 67/80 which was. .8375 I then multiplied 359 by .8375 and got 300. This 300 is the amount I am taking. Does this equal 67mgs? It reads on the scale .300 grams. I don't know what to do. (When I added the weights of the individual capsules I left off the decimal points at the beginning of the weights.) Did this mess things up? I am very confused. I don't know anything about math. I am using the Gemini 20 digital scale. I am so sorry. I don't want to be a burden. I just need so much help to figure this out.

I think I have figured it out. I haven't started taking 60 mg capsules yet. I want to make sure I am actually reducing to 60 mg when I make my next reduction on Saturday. I combined the weight of 5 80 mg capsules which equaled 1796 mgs by weight. Then divided by 5 and got 359 mgs average weight of 80 mg capsules. To get 67mgs I divided 67 by 80. .8375 Then I multiplied the average weight 359 mgs by .8375 and got 300.6625 I rounded down to 300 mgs weight which equals 67mgs. On Saturday I will reduce 10 percent of 300 mgs weight which is 270mgs. Then I will be taking 60.3mgs. Is this correct?

[Altostrata]

359mg weight = 80mg drug

 

.8375 x 359 = 300.6625

 

I would round UP from 300.6625mg to 301mg weight = 67.07mg drug

 

90% of 301mg is 270.9mg = 60.37mg drug

 

You can check your calculations with 4.4875mg weight = 1mg drug (359/80)

[Marsha]

359mg weight = 80mg drug

 

.8375 x 359 = 300.6625

 

I would round UP from 300.6625mg to 301mg weight = 67.07mg drug

 

90% of 301mg is 270.9mg = 60.37mg drug

 

You can check your calculations with 4.4875mg weight = 1mg drug (359/80)

Thank you! I have another question? On Saturday I will be opening a new vial of 80 mg ziprasidone. Do I need to go through the process of finding the average weight of the new vial and then do the calculations to get 60.37 mgs of the drug?

[Altostrata]

I would if I were you. It's another lot from the manufacturer.

[Buffy]

Oh how i wish i had found this forum sooner!

 

My doctors dropped me 20mg per week, then would up in 20mg. My dose was changed to "help" my menstural cycle going from 60mg one week to 100mg during pms then back to 60mg when the cycle started!

 

Im just so angry. I havent taken zeldox in a year but the akathisia this year has me on a knifes edge. Ive been manic off it. Raging. I am healing but i am haunted.

[Kelmo137]

so ive been on geodon 12 years. my doses changed throughout the years but i always took it once at night, no food before bed. and the doctor never once told me about taking it twice with food. so when i start my ween im assuming i should do it right by dosing twice a day. my dose now is 80mg. so should i do 40 mg twice a day and ween 10 percent of 40 mg. so say first day of the ween take 39 mg twice. or whatever the math is for 10 perecnt of that. ive told my doctopr many times how weening was hard since they are caps and he had absolutley no advice on how to do the math and make the caps smaller. now i know it comes in liquid. thanks to this amazing website. my local pharmacy refuses to order liquid for me because money is more important. will the big chains like cvs do it. i cannot afford a compound and my math is horrible and making up the caps is stressful.

[brassmonkey]

Your thinking is correct but the numbers are not. If your daily dose is 80mg and you want to do a 10% reduction the calculation is:

 

80 X .9 = 72

 

Your reduced daily dose would total 72mg. If you want to take your meds twice a day each dose would be 36mg.

 

Some people find that a full 10% reduction can be quite a shock and cause heavy symptoms. Might I suggest trying a Brassmonkey Slide. It will still give you a total reduction of 10% but spreads out the reduction over four weeks to help reduce the symptoms. Many of our members are using it with great success. It calls for more calculations, but once you understand them it's quite simple. Just ask and I'll explain more.

[ChessieCat]

2 hours ago, brassmonkey said:

Might I suggest trying a Brassmonkey Slide. It will still give you a total reduction of 10% but spreads out the reduction over four weeks to help reduce the symptoms. Many of our members are using it with great success. It calls for more calculations, but once you understand them it's quite simple. Just ask and I'll explain more.

 

Here's the topic link.  Please ask questions about the BM Slide in that topic:

 

the-brassmonkey-slide-method-of-micro-tapering