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Geodon Tapering

This entry was posted in Antipsychotic on by .
Medically Reviewed Fact Checked

Last Updated on August 8, 2022 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Alternative to Meds Center understands that Geodon tapering is best done carefully and gradually to avoid some of the more extreme withdrawal phenomena that are possible.

Antipsychotics given during a crisis often end up becoming a lifetime of being medicated, along with all of the drug’s side effects. In over 75% of the cases, we have found that people can navigate their lives after having withdrawn from the drugs.

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Top 5 Reasons for Geodon Tapering

  • The initial crisis has passed.
  • A preference for natural, holistic strategies to maintain health.1
  • Drug effects caused too great a decline in quality of life.1,2,9
  • Side effects: akathisia, tardive dyskinesia, or other muscle movement disorders.*6,7,8
  • Decreased efficacy.1,2,9

*NAMI and the FDA label report that extrapyramidal (muscle movement) disorders are linked to drugs such as Geodon.8,11

There are many factors to consider regarding tapering from atypical antipsychotic medications such as Geodon, the two major ones being inefficacy and the overwhelming side effects that reduce the person’s quality of life. These 2 factors play a role in limited patient compliance to drug therapy, according to Burton’s 2006 Review published in the Journal of Psychopharmacology.10

tapering off geodonPatients diagnosed with schizophrenia or mania associated with bipolar disorders have serious challenges facing them, not the least of which is the long-term efficacy or lack thereof in drug-based treatments. Another challenge is the significant side effects that are commonly viewed as intolerable when taking antipsychotics, especially when long-term use is often a default strategy in traditional treatment settings.9 Side effects are presented further down in more detail. There are other approaches to be considered.

A double-blind study from 2005 demonstrated these two challenges clearly, in that the vast majority of persons taking antipsychotic medications, namely perphenazine, ziprasidone, quetiapine, risperidone, and olanzapine, for chronic schizophrenia opted to discontinue their medication before the end of the 18-month trial, because of intolerable side effects or a dwindling efficacy of the drugs they were assigned in the study.1

Studies have been done showing this reduction in efficacy that has led many physicians and caregivers to take a closer look at other treatment options than simply drugging the patient for life. There is evidence that long-term use of antipsychotic medications actually can cause the brain to shrink over time, and that follow-ups performed 7 years and 15 years later of those who managed to safely discontinue the medication had better outcomes than those who continuously took antipsychotic medications for the same numbers of years.2,3

Geodon Tapering Guidelines and Schedule

Antipsychotic tapering is the most difficult drug class of all, potentially more severe than the very substantial difficulties that are encountered in benzodiazepine or opiate withdrawals. Please note: the Information given here is meant to be discussed with your prescribing physician, and certainly NOT to be self-administered without adequate support.

Safe Geodon Tapering Guidelines include:
  • geodon tapering guidelinesFind medical support. Geodon tapering should be inpatient or at least medically monitored.
  • A person has the best chance of success if stable at the start of the taper.12
  • Obtain the lowest dose (20mg blue/white) to configure the decreasing dosages during the taper.
  • Contract for safety — a written, signed agreement of cooperation in the event that a person begins spiraling out of control, to follow medical advice.34
  • Take caffeine completely off the table, including coffee, energy drinks, chocolate, OTC pain relievers, and all other forms of stimulants — these should be eliminated.23,35
  • No recreational marijuana or other drug or alcohol use. 17,18,25
  • Manage blood sugar through diet. 16
  • Aerobic/cardio exercise for mental health benefits.19,21
  • Discuss managing other medications you are also taking with your prescriber.12,20
  • Estimate the length of time it may take to complete your taper with your physician.12,20
  • Research Geodon withdrawal symptoms so you are prepared and aware should these occur.
  • Consult your prescriber should red flags such as not eating, sleeping, or other changes occur.22,25,26
  • Discuss the possibility of using bridge medications if needed with your physician.
  • Practice calming activities, light work, yoga, mindfulness awareness training, Tai Chi, Qigong, relaxation exercises, hobbies, but limit stimulating media.21,36-39
  • Many alternative therapies are listed on our antipsychotic alternatives page.
Medical support for your Geodon taper

Antipsychotic tapering including Geodon tapering can be more complex than an outpatient setting can easily accommodate. However, if inpatient treatment is not possible then we suggest finding a holistic psychiatrist in your area or at least a prescribing physician who is willing and confident they can assist you. Please share the information here with the physician you plan to work with.

Do not initiate tapering unless stable

Stable, in this case, means sleeping and eating well, not experiencing bouts of anger or fighting with everyone around you, not experiencing overwhelming or unpredictable mood swings, hallucinations, compulsive behaviors, etc. Get to a stable point first where symptoms are controlled. This is the best chance of success.12

The smallest milligram dose Geodon to use for the taper

Discuss being prescribed the smallest milligram dose to use for the taper. In this case, it is the white-blue 20mg.

You would not drop to the lowest dose but your prescriber will gradually reduce the dosage using the smaller pills to configure the reductions, slowly over time.

If you are on 80mg your prescriber can use 3 X 20mg pills to transition you down to 60mg, etc. Smaller dosing than 20mg will require opening up the capsules which will be explained below.

Percent of Geodon reduction and the duration between cuts

Configuring percentage cuts, and how long to wait between adjustments will differ from person to person. As an example, and not to be construed as instructions, a person who took Geodon for 10 years might expect 10 months for tapering, as a rough estimate, aiming for a 10% reduction per month. However, this may need significant adjusting according to the intensity of withdrawals, and the overall health of an individual as well as how long it may take for the adjustment to settle out and the person be stable for 2 weeks or so. A stable resting point is desirable at each level. Stable means not manic; it means you are sleeping, eating regularly, you are keeping a good routine, and not angry or experiencing wild emotional swings. As another example, for a person who took antipsychotics for one month, the reduction might look more like 10-25% every few weeks, again extending the time between dosage cuts as needed to become asymptomatic. For instance, two weeks between cuts would be a good estimate, that would be adjusted on an individual basis. Your prescribing physician will not want to drop to the next cut until you are without withdrawal symptoms for about 2 weeks. Cutting Geodon into less than 20mg cuts can be a bit challenging. These smaller increment cuts may require opening the pills and dividing up the powder.

Your prescriber may recommend that you purchase empty gel caps at a pharmacy or health food store. You will also need a digital scale that can weigh very small amounts, down to 1/1000 of a gram. Guesstimating what 1/2 (10mg) or 1/4 (5mg) the amount of the 20mg powder inside a capsule is not recommended, but weighing the powder exactly is a better strategy. As an example, if the cut your prescriber or caregiver has recommended is 10mg, you would use half the powder and put it into the empty gel cap. Always store the medications in a light-proof bottle like the original container. Be sure to note what you adjusted it to so that you do not get confused. Keeping a written log is recommended to help keep on track. If this is too much for you to do, speak to your physician and consider using a compounding pharmacy to do it for you.

Notes on sleep

If sleep is an ongoing issue, there are non-drug alternatives such as magnesium, melatonin, vitamin B complex, and others15 you can research and implement. Ask your doctor to recommend alternative therapies such as CBT.14 For otherwise unresolvable sleep difficulties, a non-antipsychotic medication may help get your sleep back on track before beginning your taper.

Notes on rapid Geodon cessation

Some people have a bad reaction to antipsychotics based upon certain genetic polymorphisms,24 or other adverse effects that could signal the need for immediate cessation of the medication. Such reactions might include certain movement disorders like tardive dyskinesia, akathisia, metabolic disorders including diabetes, life-threatening rash/skin eruptions, Stevens-Johnson syndrome,31 unmanageable irritability as a result of the medication, or other ADRs (adverse drug reactions). Where emergency medical procedures are needed, these must be done in a hospital setting with life-saving protocols and personnel in place. At Alternative to Meds Center, this service is not possible.

Contracting for safety with a trusted person

A person who has been on antipsychotic medication for various reasons is subject to quite severe reactions while coming off the medication. A person who is sleeping well, eating, has put an ordered lifestyle in place, and is tolerating the medication would be less subject to going off the rails. However, reactions such as becoming manic might suddenly make it hard for you to follow medical advice or the advice of your caregiver. Changes such as becoming suspicious of others, or becoming unreasonably argumentative or off-track in other ways are common signs that the taper needs to be slowed. Putting an agreement of cooperation in place before beginning the taper is a safety net that can remind you of the need to follow doctor’s orders, or else, as you have agreed, that the police or going back to the hospital will be necessary. These agreements are to keep you safe and to ensure the taper goes slowly and safely, even if it seems like you would rather go more quickly. We recommend putting a contract for safety in place to ensure the best chance for your successful outcome. You can read more about contracting for safety, sometimes called a “Ulysses contract” in the referenced BMJ publication.34

Eliminate all forms of caffeine or other stimulants

Stimulants such as caffeine can be disastrous on an antipsychotic taper. Under other circumstances, caffeine might have provided a lift in mood, especially to counteract the sedating effects of neuroleptic medications. However, coming off these medications coupled with stimulants will likely trigger an accelerated flood of dopamine, and accompanying mania or other psychiatric symptoms. This could easily land the person in the hospital or at other kinds of risk. Avoid caffeine and other stimulants while tapering antipsychotics.23 Caffeine is commonly found in coffee, chocolate, and energy drinks, but is also found in common medications as well, such as Tylenol© or acetaminophen and aspirin.35 As a note, there are many other prescribed medications that can affect the mechanics and distribution of neurotransmitters that could trigger similar overstimulation, and more on these types of drug interactions can be found below.

Quit recreational use of marijuana

A person may have landed up in a psych ward after marijuana triggered a drug-induced psychotic episode. The THC in recreational marijuana can build up in the system, especially where genetic factors may inhibit breaking THC down. This can cause psychosis.17,18 Alcohol can have negative consequences as well during a taper. While on Geodon you may have tolerated recreational drugs or social drinking, but while tapering avoid such high-risk activity.25

Diet and blood sugar stabilization

Blood sugar spikes and crashes are potentially devastating to mental health. You can improve and stabilize blood sugar through diet. Avoid sugars, refined flours, and other high glycemic foods. Instead, choose protein-based meals, ample vegetables, and some fruits like berries, cantaloupe, or plums — in moderation. Multiple small meals over the day are better than one or two heavy meals that may cause blood sugar to spike and cause undesirable symptoms.16

Cardio exercise

Research has shown the many benefits of exercise, including gardening, walking, running, cycling, or anything that gets the body moving and the heart rate up.19,28 But in the case of supersensitive dopamine receptors during Geodon tapering, clearing out the excess dopamine can be assisted by cardio/aerobic exercise. This is believed at least in part because oxygen is one of the cofactors in breaking down excess dopamine.29 This activity is recommended before, during, and after tapering even though you might feel you have to force yourself at first. The grounding effects can be significant.

Managing other medications you are on

Due to the flood of dopamine, and dopamine receptor sensitivity that can occur during Geodon tapering, you do not want to mix stimulant drugs into the process. Speak with your prescriber so that these kinds of conflicting interactions can be managed well. A sequence can be worked out that will enable the least problematic path of orderly progress. Your prescriber may decide that bridge medications may be helpful to mitigate the taper.

How long is my Geodon taper going to last?

We have observed in our clients at Alternative to Meds Center that for every year taking an antipsychotic medication, you would need roughly one month on a tapering program. So for 5 years on Geodon, it may be realistic to expect about 5 months for cessation. It could take less, it could take longer. Other factors that affect the time expectations could be general health, polydrug use, sleep issues, toxic build-up of heavy metals or other toxins that should be cleared, the severity of symptoms, and many others.

Symptoms and “red flags” during the withdrawal

We recommend closely researching Geodon withdrawals so you have a good understanding of these. Sometimes it is hard to tell whether something is from withdrawal, or whether it is a returning symptom of mental health issues. Red flags to be particularly watchful for are changes in sleep or eating habits, or other lifestyle changes. In any case, discuss these changes with your prescriber so that the taper process can be adjusted accordingly. There is much to understand about neurochemistry but for a person in the middle of a taper, the overarching theme is to talk to your doctor for the safest guidance, and take it as slow as needed to be safely progressing.

Last Geodon medication cuts likely the most difficult

While research is still discovering the effects of antipsychotic medications, certain mechanics of action have been determined. Not all of the receptor sites are affected in the same way by the same drug, and while it is known that the dopamine receptors are highly affected by Geodon, other receptors such as the histamine or adrenergic or others react in differing degrees to antipsychotic medications. The results of a drug binding to multiple receptors are not fully understood.

Other factors can also differ from person to person, such as age, general health, genetics, and so on which also play a role in the rate of normalizing neurotransmitter function after drugs have altered the way hormones and natural chemicals are distributed or withheld throughout the body. It takes time — sometimes more time than would be hoped — for these wondrously complex mechanisms to return to normal. This may be why, at least in part, the last cuts are commonly the most difficult.13

There are resources you can find on our antipsychotic alternatives page that may help ease the most challenging points, for example, at the end of a taper.

Limiting stimulating media during Geodon tapering

While tapering Geodon you want to limit stimulating activities, repetitive music, TV or movies or other sources of potential dopamine overload. Instead, opt for relaxation, exercise, light work or hobbies, outside walks, stargazing, other things that are calming.21,23

Studies show quality of life improvements along with other benefits are available through the practice of yoga, Tai Chi, Qigong, and mindfulness-awareness or meditation. These provide gentle, easy to implement options to stay active, alert, and engaged along the journey to regained health.36-39

Tapering Geodon intramuscular injectable form

Antipsychotic medications are produced in various forms. Geodon (ziprasidone) comes in capsules of 20mg, 40mg, 60mg, and 80mg to be taken orally with food. There is also an intramuscular injectable form, that comes in 20mg vials, that has not been studied for safety beyond a 3-day period of continuous use. Injectable ziprasidone is generally used for rapid control of agitation and not for long-term use. To taper, the dose would be converted to an oral form.6,7,8

Geodon Alternatives and Geodon withdrawal links

We have pages on our site that address Geodon alternatives that can be used during the tapering process. We strongly recommend you review these pages. Visit these quick links: Antipsychotic Alternatives and Geodon  Alternatives. You may also want to consider reading the Geodon Withdrawal page.

What is the Exact Mechanism of Action of Geodon?

The exact mechanism of action of Geodon is unknown. However, what is known is that Geodon has an effect on various central nervous center receptors and neurotransmitters (natural hormones or chemicals) that are located throughout the body and the brain. Geodon has a partially understood effect on serotonin, dopamine, and histamine receptors that affects how they function or cease to function.

geodon brain chemistryWhile much literature on drug information tends to refer to serotonin, dopamine, etc. as being “brain chemicals,” one must observe a wider view when trying to understand such a complex and amazing structure as the human body, brain, and central nervous system. Serotonergic, dopaminergic, and histaminergic receptors and transmitters (chemicals) are found primarily in the GI tract. In fact, 95% of the body’s serotonin is found in the intestines.4

Healthy bowels as well as an optimally functioning digestive system, then, would seem vitally important in the recovery of healthy neurochemistry as part of any recovery program. Alternative to Meds Center does view it this way. Many aspects of our program such as correction of diet, and support for a healthy microbiome focus on this critically important segment of healing and regaining health, to the benefit of clients who have reported great success with this approach. Through diet and supplementation, as well as deep cleansing protocols, the gut-brain axis can be well supported.40

Why So Many Side Effects from Geodon and Similar Drugs?

An intriguing question, and many researchers have delved into the subject. Histamine receptors are found in the heart, the liver, the gut, and throughout the body where histamine functions in many vital body functions.32 Likewise, dopamine receptors and the neurotransmitter dopamine are found in the kidneys, in blood vessels where dopamine acts as a vasodilator, and throughout the entirety of the immune system, where dopamine acts as a dampener of inflammation in every part of the body.9,33

Serotonin is another major neurotransmitter with incredibly complex roles 41 regulating mood, memory, the immune system, the blood, the heart, endocrine function, and uncountable other systems in the body that are necessary to survival. In fact, these three neurotransmitters, serotonin, histamine, and dopamine, have thousands of vital functions in the human body, coordinating, regulating, and optimizing healthy function throughout.

Is it any wonder then, that a drug such a Geodon, a drug that aggressively manipulates natural hormones and neurotransmitters, can have such a long list of side effects that can lead to distress or injury in virtually every organ and system of the body? And just as these changes are evident while taking antipsychotic medication, during the process of Geodon tapering these factors also play an important role. Supporting and boosting normalized neurochemical function is of prime importance.

Understanding the Role of Nutrition in Geodon Titration

Understanding the powerful role of nutrition and diet, as well as targeted dietary supplements can help reduce the discomfort and support normalization of neurochemistry during a gentle and well-supervised Geodon titration or dose reduction experience.

geodon treatment methodsThere is a growing body of research that has found nutrition also can play a powerful and significant supporting role in the treatment and management of symptoms of schizophrenia, the mania associated with bipolar conditions, and many other physical and mental symptomologies, especially those that have been somewhat carelessly relegated to drugging as a first-line and too-often sole treatment model.5

Alternative to Meds Center takes an orthomolecular, nutrition-based approach in tandem with two other important factors in recovery. These are neurotoxin removal 42 through gentle but effective methods, along with counseling and life coaching strategies to give our inpatient clients the absolute most effective set of treatment protocols available for efficient and effective recovery.

Geodon Weaning Must Be Done Slowly

Antipsychotic medications can alter the body and its neurochemistry in many ways, probably far more than is entirely understood at this time. The body has an amazing bio-capability to adapt itself to the presence of toxins and injurious substances. For example, toxins tend to be stored safely away in fatty areas, as a protective measure.43 Another example is that the body will “upregulate,” or build many new dopamine receptors where the existing ones are blocked (made inactive) by the presence of dopaminergic drugs such as Geodon, especially after long-term use. These are the types of adaptations that the body engineers when a person takes a drug continuously over a period of time.43 These same readaptations need to occur in the other direction when weaning Geodon, and it can be quite a slow journey back.

To suddenly withdraw the drug that the body has now adapted itself to in probably thousands of ways, can be disastrous, even life-threatening. Enough time must be allowed for the body to return to a drug-free state without shock, and micro-adjustments are necessary to make the transition a smooth one.

Find Out More About Alternative to Meds Center

Please contact the center where one of our friendly and knowledgeable staff is happy to help answer any specific or general questions about our Geodon tapering program, as well as assist with insurance queries and any other matters of interest to you or your loved one.

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Originally Published Dec 14, 2019 by Lyle Murphy, Founder

This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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