taking, titrating, and tapering Geodon (ziprasidone)
Brain Cooties Aren’t Contagious
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Taking & Titration Overview
One of the most important aspects of any medication is how to go about taking it. This includes:
- how much to take (the dosage or dose)
- when and how often to take it (dosing schedule or doses)
- how much to start with and how to increase the dose/dosage until you’re taking the target amount (titration or titration schedule).
Although we often disagree with them, we’ll always give you the manufacturer’s recommendations from Geodon’s full US Prescribing Information. If, for some reason, that isn’t available, we’ll use information for patients leaflets, SPCs from overseas, or whatever official sources we can find. Most doctors will give you some idea of what it will be like, and this is what every pharmacist is trained and paid to tell you.1 As “often” doesn’t mean “always”, whatever is in the PI sheet works for us a lot of the time.
We usually advocate starting at a lower dosage than recommended. One of our core philosophies is increasing the dosages as slowly as one’s condition allows, and staying at the dosage that works instead of a target dosage2. More and more doctors are agreeing with us3. You and your doctor can always discuss increasing the dosage when you need to in advance.
And since you never really know how a drug might affect you, it’s best to start when you have some time off of work. Like Friday night / Saturday morning, or your equivalent. Better still would be to get someone to stay with you or at least check on you frequently, especially if you’re the primary caretaker of young children and similar critters.4
Geodon (ziprasidone) Dosage and Doses
- For acute (short-term) treatment of schizophrenia: 20 to 80mg a day, twice a day for a total of 40 to 160mg of Geodon a day, depending on how much you need to be relatively not crazy.
- For long-term (maintenance) treatment of schizophrenia: 20mg twice a day. More if required, of course, but 40mg a day should work for most people in hospitals. In the real world it will probably take more, but with any luck you’ll be able to take a total of 40–80mg of Geodon a day.
Taking Geodon for bipolar disorder is way more complicated than for schizophrenia. The schizophrenic have all the luck. See the titration schedule below for short-term treatment. I’ll get back to you for long-term use.
Special Instructions/Best Way to Take Geodon (ziprasidone)
Always take Geodon capsules with food! This is to help prevent, or at least minimize nausea and other GI problems, and so your body can best absorb the Geodon. Taking it on an empty stomach will make Geodon pass right through you in more ways than one.
Geodon (ziprasidone) Titration (Dosage Increase)
I can’t argue with Pfizer’s recommendations. For acute (short-term) treatment:
Geodon Capsules should be administered at an initial daily dose of 20 mg twice daily with food. In some patients, daily dosage may subsequently be adjusted on the basis of individual clinical status up to 80 mg twice daily. Dosage adjustments, if indicated, should generally occur at intervals of not less than 2 days, as steady-state is achieved within 1 to 3 days. In order to ensure use of the lowest effective dose, patients should ordinarily be observed for improvement for several weeks before upward dosage adjustment
Efficacy in schizophrenia was demonstrated in a dose range of 20 mg to 100 mg twice daily in short-term, placebo-controlled clinical trials. There were trends toward dose response within the range of 20 mg to 80 mg twice daily, but results were not consistent. An increase to a dose greater than 80 mg twice daily is not generally recommended. The safety of doses above 100 mg twice daily has not been systematically evaluated in clinical trials. —Geodon PI sheet
Unlike a lot of APs, Pfizer’s dosage recommendations for bipolar disorder is also flexible. Like most APs it starts out twice as high as that for schizophrenia, and the top end is a lot higher, but at least they’re still flexible on the dosage:
[Geodon] should be administered at an initial daily dose of 40 mg twice daily with food. The dose may then be increased to 60 mg or 80 mg twice daily on the second day of treatment and subsequently adjusted on the basis of tolerance and efficacy within the range 40 mg-80 mg twice daily. In the flexible-dose clinical trials, the mean daily dose administered was approximately 120 mg. —Geodon PI sheet
Normally I’d suggest starting out at a low dosage and slowly increasing your dosage (titrating), but due to the way Geodon works, that’s not really a good idea for someone having a manic or mixed episode. If you’re taking Geodon for bipolar depression, then starting low and increasing slowly is the way to go. This small study of combing Geodon and Depakote shows:
[T]he response and remission rates were significantly different between the two groups. The number of patients with a 50% reduction or more in the YMRS total score was 19 (86.4%) at the endpoint in the standard-dose start group and 23 (53.5%) in the low-dose start group (p=0.002). The number of patients entering remission (YMRS ≤12) at the endpoint was 17 (77.3%) in the standard-dose start group and 20 (46.5%) in the low-dose start group (p=0.018). —Effect of Initial Ziprasidone Dose on Treatment Outcome of Korean Patients with Acute Manic or Mixed Episodes
Medicine Is The Best Medicine
Brain Cooties Aren’t Contagious
One thing PI sheets and doctors infrequently discuss, and don’t go into enough detail about, is how to discontinue a medication. With some meds it’s not too bad, but with others (most notably SNRIs like Effexor and Cymbalta) it can be a nightmare if not done carefully.
How to Stop Taking Geodon (ziprasidone)
Good question! Pfizer doesn’t provide a discontinuation schedule, and Geodon’s PK is complicated. It also does some serotonin and norepinephrine reuptake inhibition and is also a partial serotonin agonist, so it’s not surprising that SSRI/SNRI-discontinuation-like symptoms have been reported with Geodon in addition to the very rare supersensitivity psychosis. On the other hand, it acts the most like an SNRI at the lower dosages. Right now I don’t know which is better, slowly like an SNRI, or quickly like the 2–3 day titration minimum.
Notes, Tips, Helpful Hints, etc. for Withdrawing Geodon (ziprasidone)
If you run mostly manic and are currently depressed when you start Geodon what do you do? Conversely, what if you’re usually depressed all the time but are having a dysphoric mania or in a mixed state?
The obvious answer is: Treat Geodon like Lamictal and either switch to it when you’re stable on another med with side effects that are actually bad for you, or start it when you’re depressed. As reality is different from the fantasy world I often live in when I write these pages, go for the fast titration when manic/mixed and the slow one when depressed. The basic rule is the same as with any crazy med: stop increasing your dosage once your symptoms are under control, but be prepared to adjust the dosage one way or the other when your symptoms return or change.
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- Geodon full US Prescribing Information
- Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
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1 And everyone has the time to do their jobs properly, when said time isn't being wasted by idiots asking for grocery store phone numbers** or they aren't playing Angry Farmers on the Faecesbooks.
2 Although not everyone has the luxury of stopping at a dosage when the symptoms abate and not increasing it unless the return. Sometimes you just have to keep going up until you reach that target dosage. E.g. you have a history of seizures that haven't yet responded to several medications.
3 Most notably Dr. Edward Faught, founder and Director of the Epilepsy Center, and vice chairman of the Department of Neurology, at the University of Alabama School of Medicine in Birmingham. His article on new antiepileptic drugs in Volume 7 issue 1 of Peer Review in Review stressed starting at low dosages, doing a slow titration, and stopping at the dosage where symptoms were under control. In Topiramate in the treatment of partial and generalized epilepsy, the one free, full-text article I could find (that's not about geriatric patients), he again stresses the low and slow approach to avoid or lessen most side effects, while still achieving seizure control in the same amount of time.
4 Assuming you have the luxury of a job, being able to cope with your symptoms not being dealt with for however many days you need to wait in order to do this, and/or someone who can and is willing to stay with you for a few days. Read enough of this site and you can tell what sort of fantasy world I live in.
If you have any questions not answered here, please see the Crazymeds Geodon discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.net)
|Last modified on Tuesday, 24 September, 2013 at 12:14:24 by JerodPoore||Page Author Jerod Poore||Date created Friday, 28 December 2012 at 12:49:43|
|“Geodon (ziprasidone): a Review for the Educated Consumer.” by Jerod Poore is copyright © 2012 Jerod Poore||Published online 2012/12/28|
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|Plain text:||Poore, Jerod. “Geodon (ziprasidone): a Review for the Educated Consumer.” Crazymeds (crazymeds.net). (2012).|
Geodon, and all other drug names on this page and used throughout the site, are a trademark of someone else. Geodon’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, and 2015 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList,
NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
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‘Everything is true, nothing is permitted.’ - Jerod Poore
1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.