Dr. Bob's Psychopharmacology Tips

Tapering medication

Date: Thu, 23 Mar 1995 17:17:49 -0600
From: Stephen R Saklad <Saklad@uthscsa.edu>
Subject: Tapering medication

While it has never been tested (so take it for what it's worth), I usually do tapers at a first order rate as opposed to zero order rate. This means reduce the dose a fixed percentage (of the previous dose not original dose) at a time instead of "x mg every 3 days."

This is based on several assumptions, but mostly that receptors tend to turn over with a half-life of 5-7 days. This is about the same as most proteins, so it appears to fairly general. If you do the taper as a first order decrease with a half-life of 168 hr (1 wk) then you should not be able to get into trouble ... everything is almost at steady state the whole time. This does tend to give you a real long taper, but you can trade time vs risk and shorten the half-life as needed. The most odd thing about using this schedule is how long you wind up on the lowest possible dose before D/C.

I have a nifty Excel spreadsheet that does this (about a half-hour to make it from scratch).

Date: Mon, 26 Jun 1995 22:17:14 -0400 (EDT)
From: John Chapman Urbaitis <jurbaiti@welchlink.welch.jhu.edu>
Subject: Tapering medication

Another tool for helping patients taper/withdraw is less available now than formerly: liquid meds with the pt not knowing exactly the mg dose. While there are definite physiological components to the withdrawal syndrome, the psychological cognitive knowledge of the dose numbers going down has real impact to many people.

From: LJGROLD@aol.com (L.James Grold M.D.)
Date: Tue, 20 Feb 1996 00:03:44 -0500
Subject: Tapering medication

Empirically I have come to the same conclusion about the rate of taper. It has worked out to roughly 10% per week -- much slower than most have recommended. However my patients many of whom have been overwhelmed by withdrawal effects are pleased with this slow a taper. I have noted the peak of withdrawal about 3-5 days after the last reduction and I like to give the patients a few days' respite before the next onslaught.

Today I saw a woman who told me that she was stuck with 37.5 mg of venlafaxine. On checking the rate of withdrawal, on each occasion she halved the medication and got such severe withdrawal symptoms that she became resigned to taking this the rest of her life. She told me that she believed she had become an addict.

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