From the Guidelines
A recommended tapering schedule for a 49-year-old female taking Percocet 5/325 mg every 8 hours would involve gradually reducing the dose by 10% per month or slower, as suggested by the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1.
Tapering Schedule
To minimize symptoms and signs of opioid withdrawal, the taper should be individualized based on patient goals and concerns.
- Begin by reducing the dose by 10% every 4 weeks, which translates to a decrease of 0.5 mg of oxycodone every 4 weeks.
- For example, the patient can start by taking Percocet 5/325 mg every 8 hours for 4 weeks, then reduce to Percocet 4.5/325 mg every 8 hours for the next 4 weeks, and continue this pattern until the dose is reduced to a manageable level.
- Throughout the taper, monitor for withdrawal symptoms such as anxiety, insomnia, muscle aches, nausea, or increased pain, and adjust the taper schedule as needed.
- Adjunctive treatments like acetaminophen, NSAIDs, or non-pharmacological approaches such as physical therapy may help manage pain during the taper.
- Hydration, regular exercise, and adequate sleep can also ease the transition.
Importance of Medical Supervision
If withdrawal symptoms become severe, the taper may need to be slowed, and medical supervision is strongly recommended throughout this process 1.
- Clinicians should follow up frequently (at least monthly) with patients engaging in opioid tapering, and team members (e.g., nurses, pharmacists, and behavioral health professionals) can support the clinician and patient during the ongoing taper process.
- Clinicians should remain alert to signs of and screen for anxiety, depression, and opioid misuse or opioid use disorder that might be revealed by an opioid taper and provide treatment or arrange for management of these comorbidities 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 49-year-old female taking Percocet (oxycodone/acetaminophen) 5/325 mg every 8 hours, a realistic tapering schedule could be:
- Reduce the dose by 25-50% every 2-4 days, for example:
- Day 1-4: 2.5/162.5 mg (half of 5/325 mg) every 8 hours
- Day 5-8: 1.25/81.25 mg (half of 2.5/162.5 mg) every 8 hours
- Continue tapering until the dose is 0 mg
- Monitor the patient closely for signs and symptoms of withdrawal, such as anxiety, insomnia, or restlessness, and adjust the tapering schedule as needed 2 Key points:
- Taper the dose gradually to avoid withdrawal symptoms
- Monitor the patient closely for signs and symptoms of withdrawal
- Adjust the tapering schedule as needed to minimize discomfort and risk of relapse
From the Research
Tapering Schedule for Percocet
To generate a realistic tapering schedule for a 49-year-old female taking Percocet (oxycodone/acetaminophen) 5/325 mg every 8 hours, we can consider the following strategies:
- Gradual reduction of doses over time to minimize withdrawal symptoms 3, 4
- Hyperbolic tapering, which involves reducing doses by a fixed percentage at regular intervals 5, 3, 4
- Tapering to doses much lower than therapeutic minimums before complete cessation 3, 4
Proposed Tapering Schedule
Based on the available evidence, a proposed tapering schedule for Percocet could be:
- Reduce the daily dose by 10-20% every 1-2 weeks, with the goal of reaching 50% of the original dose in 4-6 weeks
- Continue to taper at a slower rate, reducing the dose by 5-10% every 2-4 weeks, until a dose of 1-2 mg of oxycodone per day is reached
- At this point, the dose can be reduced by 0.5-1 mg every 1-2 weeks until complete cessation
Considerations
It is essential to note that tapering schedules should be individualized and tailored to the patient's specific needs and tolerance 6, 4. The use of ondansetron, as described in 7, may also be considered to alleviate withdrawal symptoms. However, more research is needed to determine the effectiveness of this approach.
Key Points
- Gradual tapering is essential to minimize withdrawal symptoms
- Hyperbolic tapering may be an effective strategy for reducing doses
- Tapering to doses much lower than therapeutic minimums may be necessary before complete cessation
- Individualized tapering schedules are crucial to ensure patient safety and comfort 6, 5, 3, 4, 7