How do I safely taper off oxycodone (opioid analgesic)?

How to Safely Wean Off Oxycodone

For patients on short-term oxycodone (weeks to months), taper the dose by 25-50% every 2-4 days while monitoring for withdrawal symptoms; for long-term users (months to years), use a much slower taper of 10% per month or less, calculated as 10% of the current dose at each step, not the original dose. 1, 2

Tapering Strategy Based on Duration of Use

Short-Term Users (Days to Weeks)

• Reduce oxycodone by 25-50% every 2-4 days until discontinuation 1
• Patients with minimal exposure (3 weeks or less) have limited physical dependence and can taper more rapidly than long-term users 2
• Monitor closely during each reduction for signs of withdrawal 1

Long-Term Users (Months to Years)

• Use a hyperbolic taper of 10% per month or slower, which may take several months to years 3, 2
• Each new dose should be 90% of the previous dose, not a straight-line reduction from the starting dose 3
• This exponential reduction approach is the most promising strategy for preventing withdrawal symptoms 4
• Very slow tapers with pauses may be necessary to allow gradual accommodation to lower doses 3

Monitoring for Withdrawal Symptoms

Watch for these specific signs during tapering:

• Psychological symptoms: dysphoria, irritability, insomnia, anhedonia, anxiety, or vague sense of being unwell 2
• Physical symptoms: muscle aches, sweating, nausea, gastrointestinal discomfort 2, 5
• Critical pitfall: Nausea alone can be the sole manifestation of opioid withdrawal, even without other classic symptoms 5

Managing Withdrawal Symptoms

If withdrawal symptoms emerge during tapering:

• Immediately slow or pause the taper - raise the dose back to the previous level and taper more slowly by increasing intervals between decreases or decreasing the amount of change 1
• Consider adjunctive medications: clonidine or tizanidine for general withdrawal, trazodone for insomnia, gabapentin for anxiety/irritability, loperamide for GI symptoms 2
• Small dose decreases initially can address patient anxiety and build confidence in the process 3

Reverse Analgesic Ladder Approach

When reducing postoperative or post-procedural pain medications:

• Wean opioids first, then stop NSAIDs, then stop acetaminophen 3
• This prioritizes elimination of the highest-risk medication class first 3

Critical Warnings

• Never abruptly discontinue oxycodone in physically-dependent patients - this is unacceptable medical care and carries overdose risk 1, 3
• Sudden cessation is no more appropriate with opioids than with antihypertensives or antihyperglycemics 3
• For postoperative patients, prescribe no more than 5-7 days of opioids to minimize physical dependence 3
• Immediate-release formulations are preferred over extended-release during tapering 3

When Tapering Fails

If the patient cannot tolerate tapering despite slow reductions:

• Consider switching to buprenorphine/naloxone for a controlled transition off full opioid agonists 3
• Remain alert for unmasked anxiety, depression, or opioid use disorder that may emerge during tapering 3
• The target dose may not be zero - some patients benefit from resumption at lower doses rather than complete elimination 3
• Close observation and clinician availability to treat symptoms are critical throughout the process 3