What is the proper taper of oxy codone (oxycodone)?

Proper Tapering Protocol for Oxycodone

For patients on long-term oxycodone therapy, a taper of 10% per month or slower is recommended to minimize withdrawal symptoms and maximize success.1, 2

General Tapering Principles

• Tapering decisions should be made collaboratively with patients, as patient agreement and interest in tapering is a key component of successful tapers 1
• For patients who have been on oxycodone for ≥1 year, tapers of 10% per month or slower are better tolerated than more rapid tapers 1
• For patients on shorter-term therapy, a taper of 10% per week may be appropriate as a starting point 2
• The FDA recommends tapering by 25% to 50% every 2 to 4 days for patients who no longer require therapy but may be physically dependent 3

Recommended Tapering Schedule

• For long-term users (≥1 year): Reduce dose by 10% of the original dose per month 1
• For shorter-term users: Consider a 10% reduction per week 2
• Example of a 10% monthly taper for a patient on 30mg daily:
  • Month 1: 27mg daily
  • Month 2: 24mg daily
  • Month 3: 21mg daily
  • Month 4: 18mg daily
  • Month 5: 15mg daily
  • Month 6: 12mg daily
  • Month 7: 9mg daily
  • Month 8: 6mg daily
  • Month 9: 3mg daily
  • Month 10: Discontinue 2

Managing the Taper Process

• Follow up frequently (at least monthly) with patients during the tapering process 1
• Monitor for withdrawal symptoms including anxiety, insomnia, abdominal pain, vomiting, diarrhea, diaphoresis, mydriasis, tremor, and tachycardia 1
• If withdrawal symptoms occur, slow the taper rate further 1
• Tapers may need to be paused and restarted when the patient is ready 1
• After reaching the smallest available dose, extend the interval between doses until opioids can be stopped 1
• Never abruptly discontinue oxycodone in a physically dependent patient 3

Adjunctive Therapies for Withdrawal Management

• α2-adrenergic agonists like clonidine can help attenuate withdrawal symptoms 1, 2
• Lofexidine is FDA-approved specifically for control of opioid withdrawal symptoms 1, 4
• Consider symptomatic treatments such as NSAIDs or acetaminophen for muscle aches and pain 1, 2
• Trazodone, tricyclic antidepressants, gabapentin, or mirtazapine may help with anxiety, insomnia, and irritability during tapering 1
• Loperamide can address gastrointestinal discomfort, but monitor for potential abuse 1

Special Considerations

• Maximize nonopioid pain treatments and address behavioral distress for patients struggling with tapering 1
• Consider buprenorphine as an alternative for patients with opioid use disorder or those unable to tolerate tapering 1
• Advise patients about increased overdose risk if they return to previously prescribed higher doses 1
• Offer naloxone for overdose prevention during the tapering process 1
• Avoid ultrarapid detoxification under anesthesia due to substantial risks 2

Common Pitfalls to Avoid

• Tapering too rapidly, which can lead to withdrawal symptoms and taper failure 1
• Failing to provide adequate follow-up support during the tapering process 1
• Not addressing underlying pain conditions with alternative treatments 1
• Abandoning patients who are resistant to tapering 1
• Not screening for anxiety, depression, or opioid use disorder that may be revealed during tapering 1

Alternative Approaches

• For supervised settings, the Mayo Clinic approach uses a structured taper over 3 weeks with high completion rates 1, 2
• For patients taking oxycodone less than once daily, no formal taper is needed 1
• For patients with significant psychiatric or medical comorbidities, inpatient tapering may be more appropriate 1