Jump to content

whatisbrain: Acceptable rate of risperidone reductions based on Horowitz paper


whatisbrain

Recommended Posts

Hello all. First, I apologize for not having a more extensive withdrawal schedule in my signature, but unfortunately I haven't kept records and have forgotten when or how I got off some previous medications I was on. At this point I have one left, Risperidone .875 mg (.5 mg pill, .25 mg pill, and half a .25 mg pill, altogether .875 mg per day). This is the dose I have been taking for the last three months, and I have not had any symptoms during that time. I have read Mark Horowitz's amazing paper on hyperbolic tapering, and its "Supplemental" link on the left has a clear chart for Risperidone reductions that step down receptor occupancy slowly. What I didn't see in the paper, perhaps because I missed something while reading, is how long to stay at each level. Of course everyone's brain adjusts differently, but just a general idea - is a few weeks enough if one is feeling stable, or is a few months between each level change necessary. Here is a link to the paper:

 

https://academic.oup.com/schizophreniabulletin/article/47/4/1116/6178746

 

The charts for dose level vs. receptor occupancy for many drugs are listed in tables in the link on the left where it says "Supplemental"

 

Thank you all in advance.

Edited by manymoretodays
added name to title

Started at risperidone 1.25 mg, reduced by .125 mg every three months, to .875 mg.

Reduced by .01 mg per week from .88 mg to .84 mg.

Reduced by .01 mg per 4 days from .84 mg to .65 mg.

Reduced by .01 mg per 5 days from .65 mg to .50 mg.

Reduced by .01 mg per 6 days from .50 mg to .40 mg.

At .40 mg as of May 2, 2022.

Link to comment
  • Moderator

Dear Whatisbrain, 

welcome to SA. I think in that paper they mention 25-50% every 3 months or 10% every month (abstract). Nobody has done research on what is optimal and even if they did, optimal may vary for various people - I am currently only able to go about 3-4% a month at the lower doses of citalopram. 

 

My suggestion would be to go as slow as possible if you are not experiencing serious medication side effects and minimize the chance of withdrawal. If you had been prescribed antipsychotics for psychotic episodes, if you go too fast and that causes psychosis you may risk being put into hospital or forced the drugs or may believe that you need them forever. You may be told that you have relapsed and need life-long treatment. If that was not a danger then I'd suggest trial and error - try 10% a month and see if that is ok and if it becomes too hard, go slower. 10% a month seems tolerable to most people here. 

 

There is also a smoother method - Brassmonkey's slide taper in this forum. You decrease by 2.5% every week and then hold for 2 weeks. I currently do 0.5% every 4-5 days. It's snail's pace and it's frustrating but I have emotional symptoms still and some insomnia so need to do it this way. 

 

That's the best guess that I can provide until more studies are done. 

OMW

I am not a doctor and this should not be considered medical advice. You can use the information provided in whatever way you want and all decisions on your treatment are yours. 

 

If you would like to get a response from me directly please type @Onmyway some place in your message so I get notified of your post. I am not able to follow all of the threads all the time.

 

Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg,  xanax prn, wellbutrin for a few months, trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg, xanax prn (rarely used)

Aug 2018 - citalopram 40 mg (self titrated up)

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax - 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st citalopram 2.0 mg (liquid), klonopin 0.25 once a week, 

citalopram (liquid) 4/14/19 -1.8 mg, 5/8/19 - 1.6 mg,  7/27/19 -1.5 mg,  8/15/19 - 1.35, 2/21/21 - 1.1 (smaller drops in between), 6/20/21 - 1.03 mg, 8/7/21- 1.025, 8/11/21 - 1.02, 8/15/21 - 1.015, 9/3/21 - 0.925 (fingers crossed!), 10/8/21 - 0.9, 10/18/21 - 0.875, 12/31/21 - 0.85, 1/7/22 - 0.825, 1/14/22 - 0.8, 1/22/22 - 0.785

 

Supplements: magnesium citrate and bi-glycinate

 

Link to comment

Thank you, that is very clear and helpful.

Started at risperidone 1.25 mg, reduced by .125 mg every three months, to .875 mg.

Reduced by .01 mg per week from .88 mg to .84 mg.

Reduced by .01 mg per 4 days from .84 mg to .65 mg.

Reduced by .01 mg per 5 days from .65 mg to .50 mg.

Reduced by .01 mg per 6 days from .50 mg to .40 mg.

At .40 mg as of May 2, 2022.

Link to comment
  • manymoretodays changed the title to whatisbrain: Acceptable rate of risperidone reductions based on Horowitz paper
  • 10 months later...

Hi @whatisbrain

Stopping by your thread to see how you're feeling. 

You haven't posted in a while, though it looks like you're keeping your drug signature up to date.

No pressure for an update if you don't feel like writing. 

Just to say I'm thinking of you and appreciate your contributions to the site. 

Wishes of peace and healing, 

A. 

1996-2018 - misc. polypharmacy, incl. SSRIs, SNRIs, neuroleptics, lithium, benzos, stimulants, antihistamines, etc. (approx. 30+ drugs)

2012-2018 - 10mg lexapro/escitalopram (20mg?)    Jan. 2018 - 10mg -> 5mg, then from 5mg -> 2.5mg, then 0mg  -->  July 2018 - 0mg

2017(?)-2020 - vyvanse/lisdexamfetamine 60-70mg    2020-2021 - 70mg down to 0mg  -->  July 2021 - 0mg

March-April 2021 - vortioxetine 5-10mg (approx. 7 weeks total; CT)  -->  April 28th, 2021 - 0mg

supplements: magnesium powder (dissolved in water) as needed throughout the day; 1 tsp fish oil w/ morning meal; 2mg melatonin 9pm 

August 1, 2022 - 1 mg melatonin, approx. 10:30pm

 

Courage is fear that has said its prayers.  - Karle Wilson Baker

love and justice are not two. without inner change, there can be no outer change; without collective change, no change matters.  - Rev. angel Kyodo williams

Holding multiple truths. Knowing that everyone has their own accurate view of the way things are.  - text on homemade banner at Afiya house

 

I am not a medical professional; this is not medical advice. 

Link to comment

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×
×
  • Create New...

Important Information

Terms of Use Privacy Policy