Tapering Opioids
- Decisions regarding tapering schedule should be made on an individual basis after a discussion with the patient. In general, the longer the patient has been on opioids, the slower the taper should be. Clear written and verbal instructions should be given to patients and their families to explain the slow taper protocol to minimize withdrawal symptoms.
- Taper by 20-50% of original dose per week for patients who do not have addiction issues. The goal is to minimize adverse/withdrawal effects.
- Clonidine 0.1 mg 2-3x daily may be used to control symptoms of abstinence syndrome (nausea, diarrhea, muscle pain, and myoclonus). Consider using adjuvant agents such as antidepressants to manage irritability and sleep disturbance, or antiepileptics for neuropathic pain.
More information available at: Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain
Suggested Tapers For...
Methadone
Morphine SR/CR
Oxycodone CR
1. Decrease dose by 20-50% per day until you reach 30 mg/day
1. Decrease dose by 20-50% per day until you reach 45 mg/day
1. Decrease dose by 20-50% per day until you reach 30 mg/day
2. Then decrease by 5 mg/day every three to five days to 10 mg/day
2. Then decrease by 15 mg/day every two to five days
2. Then decrease by 10 mg/day every two to five days
3. Then decrease by 2.5 mg/day every three to five days
