What is a safe tapering schedule for a patient taking oxycodone (oxy) 10 mg 4 times daily?

Oxycodone Tapering Schedule for Patient on 10 mg Four Times Daily

The most appropriate oxycodone tapering schedule for a patient taking 10 mg four times daily (40 mg total daily dose) is to reduce by 25-50% every 2-4 days while monitoring for withdrawal symptoms, with smaller percentage reductions as the dose decreases. 1

Initial Assessment and Planning

• Before beginning the taper, explain to the patient that tapering will be individualized based on their tolerance, with the goal of minimizing withdrawal symptoms while safely discontinuing the medication 2
• Discuss with the patient that many people actually feel and function better after tapering off opioids, which can help address anxiety about the process 2
• Set realistic expectations that some withdrawal symptoms may occur but can be managed with supportive care 2

Tapering Schedule

Week 1:

• Reduce from 10 mg four times daily (40 mg/day) to 7.5 mg four times daily (30 mg/day)
• This represents a 25% reduction from the original dose 1
• Monitor for withdrawal symptoms including drug craving, anxiety, insomnia, abdominal pain, vomiting, diarrhea, diaphoresis, tremor, and tachycardia 2

Week 2:

• If Week 1 reduction was well-tolerated, reduce to 5 mg four times daily (20 mg/day)
• If the patient experienced significant withdrawal symptoms, consider a smaller reduction to 6 mg four times daily (24 mg/day) 2

Week 3:

• Reduce to 2.5 mg four times daily (10 mg/day) if previous reductions were well-tolerated
• For patients who struggled with previous reductions, consider a smaller reduction to 4 mg four times daily (16 mg/day) 2

Week 4:

• Reduce to 2.5 mg three times daily (7.5 mg/day) 2

Week 5:

• Reduce to 2.5 mg twice daily (5 mg/day) 2

Week 6:

• Reduce to 2.5 mg once daily (2.5 mg/day) 2

Week 7:

• Discontinue completely 2

Adjusting the Taper

• If the patient experiences significant withdrawal symptoms or worsening pain, pause the taper at the current dose until symptoms stabilize 2
• Consider slowing the taper once lower doses are reached (below 10-15 mg/day total), as percentage reductions should become smaller 2
• For patients with severe withdrawal symptoms, consider extending the interval between doses rather than reducing the dose further 2

Managing Withdrawal Symptoms

• For autonomic symptoms (sweating, tachycardia), consider clonidine 0.1-0.2 mg every 6 hours as needed 2
• For insomnia, consider short-term use of trazodone or other non-benzodiazepine sleep aids 2
• For muscle aches or pain, recommend acetaminophen, NSAIDs, or topical analgesics 2
• For anxiety or irritability, consider supportive counseling and relaxation techniques 2

Special Considerations

• Never abruptly discontinue opioids in a physically dependent patient as this can lead to severe withdrawal and increased risk of overdose if the patient returns to previous doses 1
• If the patient has been on opioids for years, consider an even slower taper (e.g., 5% reduction every 2-4 weeks) 2
• If the patient has comorbid psychiatric conditions, ensure these are optimally managed during the tapering process 2
• Consider buprenorphine conversion for patients who struggle with traditional tapering approaches 2

Follow-up and Monitoring

• Schedule follow-up appointments at least monthly during the tapering process 2
• Assess for pain control, functional status, and withdrawal symptoms at each visit 2
• Screen for anxiety, depression, and suicidal ideation, as these may emerge during tapering 2
• Provide education about increased overdose risk if returning to previous doses 2

This tapering schedule follows FDA-approved labeling for oxycodone discontinuation 1 and incorporates consensus recommendations from pain management experts 2, prioritizing patient safety while minimizing withdrawal symptoms.