What is an appropriate taper for a patient on Percocet (oxycodone/acetaminophen) 5/325 mg, two tablets every 6 hours, and should they be switched to a lower potency and longer-acting opioid?

From the Guidelines

A gradual taper for a patient on Percocet 5/325 mg, two tablets every 6 hours, should reduce the dose by approximately 10% per month or slower, as recommended by the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1. When considering a taper, it's essential to weigh the benefits and risks of continuing opioid therapy versus tapering, and to involve the patient in the decision-making process 1.

Key Considerations for Tapering

• The patient's agreement and interest in tapering are crucial for a successful taper 1.
• The taper plan should be individualized based on the patient's goals, concerns, and clinical circumstances 1.
• A taper slow enough to minimize symptoms and signs of opioid withdrawal should be used, with a reduction of 10% per month or slower likely to be better tolerated for patients who have taken opioids long-term 1.
• Clinicians should collaborate with the patient on the tapering plan, including decisions on the rate of tapering and when pauses in the taper might be warranted 1.
• Frequent follow-up, at least monthly, is necessary to monitor the patient's response to the taper and adjust the plan as needed 1.

Switching to a Lower Potency and Longer-Acting Opiate

Switching to a longer-acting opioid like extended-release morphine or oxycodone may be considered to stabilize blood levels and reduce withdrawal symptoms, but this decision should be made on a case-by-case basis, taking into account the patient's individual needs and circumstances 1.

• The CDC guideline recommends maximizing nonopioid treatments for pain and addressing behavioral distress for patients struggling to tolerate a taper 1.
• Clinically significant opioid withdrawal symptoms can signal the need to further slow the taper rate 1.
• Before reversing a taper, clinicians should carefully assess and discuss with the patient the benefits and risks of increasing opioid dosage 1.

From the FDA Drug Label

When a patient who has been taking oxycodone hydrochloride tablets regularly and may be physically dependent no longer requires therapy with oxycodone hydrochloride tablets, taper the dose gradually, by 25% to 50% every 2 to 4 days, while monitoring carefully for signs and symptoms of withdrawal If the patient develops these signs or symptoms, raise the dose to the previous level and taper more slowly, either by increasing the interval between decreases, decreasing the amount of change in dose, or both.

For a patient on Percocet (oxycodone/acetaminophen) 5/325 mg, two tablets every 6 hours, an appropriate taper is to gradually reduce the dose by 25% to 50% every 2 to 4 days. The patient should be monitored carefully for signs and symptoms of withdrawal.

• If the patient develops withdrawal symptoms, the dose should be raised to the previous level and tapered more slowly.
• It is not explicitly stated in the label whether the patient should be switched to a lower potency and longer-acting opioid. 2

From the Research

Appropriate Taper for Percocet

• The patient is currently taking Percocet (oxycodone/acetaminophen) 5/325 mg, two tablets every 6 hours, which is a relatively high dose of oxycodone 3.
• To taper this patient, a gradual reduction in dose is recommended to minimize withdrawal symptoms and prevent relapse 4.
• The taper schedule should be individualized based on the patient's medical history, current dose, and response to treatment 5.
• A common approach is to reduce the dose by 10-20% every 1-2 weeks, with closer monitoring and adjustments as needed 6.

Switching to a Lower Potency and Longer-Acting Opioid

• Switching to a lower potency and longer-acting opioid, such as morphine, may be considered to reduce the risk of overdose and improve tolerability 3, 6.
• However, this decision should be made on a case-by-case basis, taking into account the patient's specific needs and medical history 4, 5.
• Oxycodone/naloxone (OXN) has been shown to have a better tolerability profile and lower risk of opioid-induced constipation compared to traditional opioid therapy with oxycodone (OXY) or morphine (MOR) 6.
• The choice of opioid and taper schedule should be guided by clinical experience and evidence-based guidelines, with careful monitoring and adjustments as needed to ensure safe and effective pain management 3, 4, 5, 6.