From the FDA Drug Label
For Medically Supervised Withdrawal After a Period of Maintenance Treatment There is considerable variability in the appropriate rate of methadone taper in patients choosing medically supervised withdrawal from methadone treatment
The medication used to wean off methadone is methadone itself, by gradually decreasing the dose.
- The rate of decrease should be determined separately for each patient.
- In hospitalized patients, a daily reduction of 20% of the total daily dose may be tolerated.
- In ambulatory patients, a somewhat slower schedule may be needed. 1
From the Research
Methadone tapering is typically done using a gradual dose reduction approach, with decreases of 20% of the current dose daily or every other day, as part of a standardized weaning protocol. The most common approach to weaning off methadone involves a gradual reduction in dose, and the specific protocol can vary based on the individual's needs and the clinical setting.
- A standardized methadone weaning protocol, as described in the study by 2, can significantly reduce methadone exposure and the duration of withdrawal symptoms.
- The protocol involves reducing the total daily methadone dose by 20% daily or every other day, as part of a 5- or 10-day wean.
- Other medications, such as clonidine, may be used to manage specific withdrawal symptoms, as discussed in the studies by 3, 4, and 5.
- However, the most recent and highest quality study, 2, suggests that a standardized methadone weaning protocol is effective in reducing methadone exposure and withdrawal symptoms, without the need for additional medications.
- The study by 6 also supports the use of a 10-day methadone wean to prevent opioid withdrawal in pediatric patients, but the protocol used in this study is less relevant to the current question.
- In general, the tapering process should be slow and gradual, with careful monitoring of symptoms and adjustment of medications as needed, to minimize withdrawal severity and increase the chances of successful discontinuation.
- Medical supervision throughout this process is essential to monitor symptoms, adjust medications as needed, and provide psychological support.