From the Research
To cross taper from Risperdal (risperidone) 2 mg twice daily to Geodon (ziprasidone), I recommend a gradual transition over several months, as suggested by the most recent and highest quality study 1, to minimize the risk of relapse and withdrawal effects.
Key Considerations
- The process of reduction should be associated with the precipitation or exacerbation of psychotic symptoms, and a slower process of reduction may minimize this effect 1.
- Slower tapering of antipsychotics may provide time for adaptations made to the presence of the medications to resolve, thus reducing the disruption to homeostatic equilibrium caused by dose reduction, potentially reducing the risk of relapse 1.
- A hyperbolic tapering approach, reducing the dose by one quarter or one half of the most recent dose, at intervals of 3-6 months, titrated to individual tolerance, may be beneficial 2.
Tapering Schedule
- Begin by starting Geodon at 20 mg twice daily with food while maintaining your full Risperdal dose for the first few weeks.
- Gradually reduce Risperdal dose by 25% every 2-4 weeks, while increasing Geodon dose to reach therapeutic levels (typically 40-80 mg twice daily).
- The final doses before complete cessation of Risperdal may need to be as small as 1/40th of the therapeutic dose to prevent a large decrease in D2 blockade when stopped 2.
Important Notes
- The overlap period is crucial because Geodon works differently than Risperdal on dopamine and serotonin receptors, and your brain needs time to adjust to the new medication.
- Be sure to take Geodon with food (at least 500 calories) to ensure proper absorption, and report any unusual side effects to your doctor immediately during the transition.
- It is essential to work closely with your doctor to determine the best tapering schedule and to monitor your condition during the transition.