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What are the withdrawal symptoms of these drugs?

Friday, 09 April 2004
Answered by: Chandra M. Gulhati
Editor,
MIMS,
New Delhi
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Q. I am taking zoset 50 mg morning and 100 mg at night time along with zipsydon ziprasidone hydrochloride 20 mg tablet at night. My doctor has asked me not to stop these drugs suddenly but to have a gradual withdrawl from these. Why is it so? What would be the further steps of the withdrawal regime? I have been taking these for almost a year. My morning dose of zosert was 100 mg which has now come down to 50 mg. What would be the mode of slow withdrawal? Does any of these two drugs cause weight increase or hair fall?

A.  You have not given the diagnosis of the disorder for which you have been prescribed the two medicines. However I will try to give the best possible answer even without this vital information. Sertraline (sold under various brand names such as Serlin, Serdep, Zert and Zosert) is used for: (a) Depression (b) Obsessive Compulsive Disorder (c) Post-traumatic stress disorder (in females). Ziprasidone is used for schizophrenia. The dose of sertraline is 50 mg once daily for two weeks; if no improvement, increase to 100 mg daily for 2 to 4 weeks; if still no improvement, increase to 150 mg for another 2 to 4 weeks and finally to 200 mg daily but never more than that. Then the dose needs to be gradually decreased to a level where desired effect is achieved. Usually it should be 50-100 mg daily. If at all a dose of 150 mg daily is to be given it should not be given for more than 8 weeks. The withdrawal should be the same way as the increase i.e. over 2 weeks. If you have already taken 50 mg twice daily (i.e. 100 mg daily) for two weeks, then it can be reduced to 50 mg once daily for another two weeks and then dropped altogether. Unfortunately the cost is not taken into account while prescribing brands, particularly when a drug is to be used for long term. While 10 tablets of Zosert 50 mg cost just over Rs. 37, other equally quality brands cost at least 33% less from very good manufacturers. Examples: Serlin from Cadila is priced at Rs. 24 while Zert (from RPG) and Serdep (from Cipla) cost Rs. 25 each. Patients are forced to spend extra for no benefit at all. Ziprasidone can be discontinued without gradual decrease of dose.

A.  You have not given the diagnosis of the disorder for which you have been prescribed the two medicines. However I will try to give the best possible answer even without this vital information. Sertraline (sold under various brand names such as Serlin, Serdep, Zert and Zosert) is used for: (a) Depression (b) Obsessive Compulsive Disorder (c) Post-traumatic stress disorder (in females). Ziprasidone is used for schizophrenia. The dose of sertraline is 50 mg once daily for two weeks; if no improvement, increase to 100 mg daily for 2 to 4 weeks; if still no improvement, increase to 150 mg for another 2 to 4 weeks and finally to 200 mg daily but never more than that. Then the dose needs to be gradually decreased to a level where desired effect is achieved. Usually it should be 50-100 mg daily. If at all a dose of 150 mg daily is to be given it should not be given for more than 8 weeks. The withdrawal should be the same way as the increase i.e. over 2 weeks. If you have already taken 50 mg twice daily (i.e. 100 mg daily) for two weeks, then it can be reduced to 50 mg once daily for another two weeks and then dropped altogether. Unfortunately the cost is not taken into account while prescribing brands, particularly when a drug is to be used for long term. While 10 tablets of Zosert 50 mg cost just over Rs. 37, other equally quality brands cost at least 33% less from very good manufacturers. Examples: Serlin from Cadila is priced at Rs. 24 while Zert (from RPG) and Serdep (from Cipla) cost Rs. 25 each. Patients are forced to spend extra for no benefit at all. Ziprasidone can be discontinued without gradual decrease of dose.

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