Carisoprodol (Soma) Tapering Duration
Carisoprodol should be tapered slowly over 4 to 9 days rather than stopped abruptly to prevent severe withdrawal symptoms including seizures, anxiety, tremors, hallucinations, and tachycardia. 1
Understanding the Urgency
Carisoprodol is a controlled substance with substantial barbiturate-like biological action and significant abuse potential. 1 The FDA has reported escalating abuse in the past decade, making it one of the most commonly diverted drugs in the United States. 1 With prolonged abuse at high dosages, carisoprodol leads to tolerance, dependence, and potentially severe withdrawal symptoms. 1
Recommended Tapering Protocol
The Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement explicitly recommends tapering carisoprodol over 4 to 9 days when discontinuing after prolonged use. 1 This timeframe is critical because:
- Withdrawal symptoms can be severe and include sedation, seizures, drug dependence, tachycardia, postural hypotension, anxiety, tremors, muscle twitching, insomnia, and auditory/visual hallucinations. 1
- Symptoms typically intensify and peak around the fourth day after abrupt cessation. 2
- The active metabolite meprobamate accumulates with chronic use, contributing to withdrawal severity. 2
Clinical Context for Tapering
The FDA label specifies that carisoprodol should only be used for short periods (up to 2-3 weeks) because adequate evidence of effectiveness for prolonged use has not been established. 3 However, when patients have been using it chronically (especially at high doses), the 4-9 day taper becomes essential. 1
Perioperative Considerations
If surgery is planned and time permits, consider tapering off carisoprodol or switching to an alternative agent before the procedure. 1 The drug should be held on the day of operation due to its central nervous system depressant effects and potential interactions with anesthetic agents. 1
Common Pitfalls to Avoid
- Never stop carisoprodol abruptly in patients with prolonged use or high-dose exposure—this can precipitate severe withdrawal including seizures. 1
- Be aware that patients may be obtaining carisoprodol from multiple sources without prescriptions, making actual consumption difficult to assess. 1
- Recognize that carisoprodol has a rapid onset of action with effects lasting 4-6 hours, requiring multiple daily doses during tapering. 1
- Document the tapering plan clearly, as withdrawal symptoms may require brief treatment with benzodiazepines (like lorazepam) or antipsychotics (like olanzapine) if severe symptoms develop. 2
Monitoring During Taper
Watch for withdrawal symptoms that typically emerge within 48 hours of dose reduction, including anxiety, tremors, muscle twitching, insomnia, hallucinations, and bizarre behavior. 2 Symptoms gradually resolve but may require symptomatic management during the taper period. 2