Tramadol Extended Release Tapering Schedule for a 54-Year-Old Female
A slow taper of tramadol extended release at 10-15% reduction every 2 weeks is recommended for this patient, with careful monitoring for withdrawal symptoms and adjustment of the taper rate as needed.
Current Medication Status
- 54-year-old female
- Currently on tramadol extended release 100mg BID (200mg daily total)
- Desires a slow taper at 10-15% reduction rate
Tapering Rationale and Approach
The CDC Clinical Practice Guideline (2022) recommends that when tapering opioids:
- Tapers should be slow enough to minimize withdrawal symptoms
- For patients on long-term opioid therapy, tapers of 10% per month or slower are better tolerated 1
- Patient collaboration in the tapering plan is essential for success
- The taper may need to be paused or slowed as patients reach lower dosages
Recommended Tapering Schedule
Phase 1: Initial Reduction (Weeks 1-2)
- Continue tramadol ER 100mg in morning
- Reduce evening dose to 75mg
- Total daily dose: 175mg (12.5% reduction)
Phase 2: Second Reduction (Weeks 3-4)
- Continue tramadol ER 100mg in morning
- Reduce evening dose to 50mg
- Total daily dose: 150mg (25% total reduction)
Phase 3: Third Reduction (Weeks 5-6)
- Reduce morning dose to 75mg
- Continue evening dose at 50mg
- Total daily dose: 125mg (37.5% total reduction)
Phase 4: Fourth Reduction (Weeks 7-8)
- Continue morning dose at 75mg
- Reduce evening dose to 25mg
- Total daily dose: 100mg (50% total reduction)
Phase 5: Fifth Reduction (Weeks 9-10)
- Reduce morning dose to 50mg
- Continue evening dose at 25mg
- Total daily dose: 75mg (62.5% total reduction)
Phase 6: Sixth Reduction (Weeks 11-12)
- Continue morning dose at 50mg
- Discontinue evening dose
- Total daily dose: 50mg (75% total reduction)
Phase 7: Final Reduction (Weeks 13-14)
- Reduce morning dose to 25mg
- Total daily dose: 25mg (87.5% total reduction)
Phase 8: Discontinuation (Weeks 15-16)
- Take 25mg every other day for 1 week
- Then discontinue completely
Important Considerations
Compounding Options
- For intermediate doses not commercially available (75mg, 25mg), request compounded capsules from a pharmacy
- Alternatively, use commercially available 50mg tablets that can be split for the 25mg dose
Monitoring During Taper
- Follow up at least monthly during the taper 1
- Monitor for withdrawal symptoms: anxiety, insomnia, abdominal pain, vomiting, diarrhea, diaphoresis, tremor 1
- If withdrawal symptoms become significant, pause the taper and maintain the current dose for an additional 2-4 weeks before resuming
Adjustments to Schedule
- The taper may need to be slowed further as the patient reaches lower doses
- Consider extending each phase to 3-4 weeks if the patient experiences difficulty
- The taper may be paused temporarily if needed, especially when reaching doses below 50mg daily
Special Considerations
- For patients over 65 years old, dose selection should be cautious, starting at the low end of the dosing range 2
- For patients with renal impairment (CrCl <30 mL/min), the maximum daily dose should not exceed 200mg 2
- For patients with hepatic impairment, the recommended dose is 50mg every 12 hours 2
Non-Pharmacological Support During Taper
- Maximize non-opioid pain management strategies
- Consider referral to physical therapy if appropriate
- Provide education about expected withdrawal symptoms and their management
- Consider psychological support during the tapering process
By following this gradual tapering schedule of approximately 10-15% reduction every 2 weeks, the patient should be able to discontinue tramadol extended release with minimal withdrawal symptoms over a 3-4 month period.