Opioid Tapering Schedule for Patient on Percocet
A slow, gradual taper over 2 years with monthly follow-up is the most appropriate approach for a patient taking Percocet 2 tablets every 6 hours, with an initial reduction of 5-10% per month to minimize withdrawal symptoms and maximize successful discontinuation. 1
Initial Assessment and Preparation
- Calculate current daily dose: Percocet (oxycodone/acetaminophen) 2 tablets every 6 hours = 8 tablets daily
- Determine oxycodone content per tablet (likely 5mg, 7.5mg, or 10mg per tablet)
- Discuss with patient:
- Rationale for tapering
- Expected timeline (2 years)
- Potential withdrawal symptoms
- Alternative pain management strategies
Tapering Strategy
Phase 1: Initial Taper (Months 1-6)
- Begin with 5-10% reduction of original dose per month 1
- Month 1: Reduce from 8 tablets to 7 tablets daily (decrease 1 tablet)
- Month 2-6: Continue at 7 tablets daily to stabilize and assess tolerance
Phase 2: Continued Gradual Reduction (Months 7-18)
- Month 7: Reduce to 6 tablets daily
- Month 10: Reduce to 5 tablets daily
- Month 13: Reduce to 4 tablets daily
- Month 16: Reduce to 3 tablets daily
Phase 3: Final Reduction (Months 19-24)
- Month 19: Reduce to 2 tablets daily
- Month 21: Reduce to 1 tablet daily
- Month 23: Reduce to 1/2 tablet daily
- Month 24: Discontinue
Medication Conversion Options
Consider converting to long-acting opioid formulations during the taper:
Buprenorphine option (Months 6-12):
- After reducing to 4-5 tablets daily, consider transitioning to buprenorphine
- Follow protocol for initiation 1:
- Discontinue all opioids the night before
- Wait for mild withdrawal symptoms
- Start with 2-4mg buprenorphine
- Titrate as needed (typically 4-8mg first day)
- For pain management, divide daily dose into 3-4 doses
- Continue slow taper of buprenorphine over remaining months
Extended-release oxycodone option:
- Convert to equivalent dose of extended-release oxycodone
- Taper extended-release formulation by 5-10% monthly
- Monitor closely for sedation and respiratory depression during conversion 2
Monthly Follow-up Protocol
Each Visit Should Include:
- Pain assessment using Brief Pain Inventory
- Functional assessment
- Withdrawal symptom evaluation
- Psychological assessment for anxiety/depression
- Medication adherence review
- Adjustment of taper rate based on patient response
Withdrawal Management
- For sympathetic hyperactivity: α2-adrenergic agonists (clonidine, tizanidine) 1
- For insomnia: trazodone or mirtazapine (short-term use) 1
- For muscle aches: acetaminophen, NSAIDs 1
- For GI symptoms: loperamide (monitor for abuse potential) 1
Non-Opioid Pain Management
- Maximize non-opioid analgesics: NSAIDs, acetaminophen (monitor total daily dose)
- Physical therapy and graded exercise program
- Cognitive behavioral therapy (proven cost-effective for chronic pain) 1
- Consider adjuvant medications based on pain type:
- Neuropathic pain: gabapentin, pregabalin
- Musculoskeletal pain: muscle relaxants
Special Considerations
- If withdrawal symptoms become intolerable, pause taper and maintain current dose for 1-2 months before resuming 1
- If pain significantly worsens, reassess pain management strategy rather than reverting to higher opioid dose
- Be alert for signs of anxiety, depression, or opioid use disorder that may emerge during taper 1
- Provide overdose education and consider naloxone prescription
Common Pitfalls to Avoid
Tapering too rapidly: Even 10% reduction per week is often too fast for long-term users; 10% per month is more appropriate for patients on long-term therapy 1
Ignoring protracted withdrawal: Symptoms like dysphoria, irritability, and insomnia may persist for months after discontinuation 1
Converting to methadone: Outpatient conversion to methadone should be avoided due to complex pharmacokinetics and high lethality risk 1
Neglecting psychological support: Psychological interventions significantly improve outcomes during tapering 1
Abrupt discontinuation: Never abruptly discontinue opioids in physically dependent patients 2