What is the recommended tapering strategy for a 52-year-old female to restart Zepboubd (likely referring to Zebutal, a brand name, with the generic name being Butalbital, Aspirin, and Caffeine) after a 2-week cessation prior to surgery, given her current dosage of 15 mg?

From the Guidelines

To restart Zebutal (Butalbital, Aspirin, and Caffeine) after a 2-week cessation, I recommend continuing the medication perioperatively to avoid acute withdrawal, as abrupt cessation is not advised, especially for long-term use 1. When considering the restart strategy, it's crucial to prioritize minimizing potential withdrawal effects and ensuring the patient's safety.

• The patient's current dosage of 15 mg should be continued, if possible, to avoid any complications related to withdrawal.
• If the medication was stopped abruptly before surgery, it's essential to restart it as soon as possible to prevent withdrawal symptoms.
• The medication should be taken as directed, and the patient should be monitored closely for any signs of withdrawal or adverse effects.
• It's also important to note that butalbital, a component of Zebutal, is a short- to intermediate-acting barbiturate with central nervous system and respiratory depressive effects, and its use should be carefully managed, especially in the perioperative period 1.
• The CDC clinical practice guideline for prescribing opioids for pain also emphasizes the importance of careful consideration when tapering or discontinuing opioids, although Zebutal is not an opioid, the principles of gradual tapering and monitoring for withdrawal symptoms can be applied to other medications with potential for dependence 1.
• However, the primary concern with Zebutal is the risk of withdrawal and the potential for seizures if stopped abruptly, especially after long-term use, making it essential to continue the medication perioperatively if possible 1.

From the Research

Tapering Strategy for Zebutal (Butalbital, Aspirin, and Caffeine)

There are no research papers provided that directly address the tapering strategy for Zebutal (Butalbital, Aspirin, and Caffeine) after a 2-week cessation prior to surgery.

General Tapering Strategies

However, the provided studies discuss tapering strategies for other medications, such as antipsychotics and SSRIs. Some key points from these studies include:

• Gradual tapering of antipsychotics over months or longer is associated with a lower relapse rate than quicker tapering 2
• Smaller dose reductions, especially at lower doses, made very gradually, may minimize the risk of psychotic symptoms 2
• Hyperbolic tapering of antipsychotics, reducing by one quarter (or one half) of the most recent dose, sequentially, at intervals of 3-6 months, titrated to individual tolerance, may minimize the risk of relapse 3
• Tapering SSRIs hyperbolically and slowly to doses much lower than those of therapeutic minimums may minimize withdrawal symptoms 4

Considerations for Tapering

It is essential to note that these studies do not directly address the tapering strategy for Zebutal, and the recommended approach may vary depending on the specific medication and individual patient factors.

• The decision to taper should be made on a case-by-case basis, taking into account the patient's medical history, current dosage, and individual tolerance.
• A healthcare professional should be consulted to determine the best course of action for tapering Zebutal or any other medication.