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Opioid-BenzosTapering Flowchart

This document provides a flowchart for tapering benzodiazepines and opioids. It outlines basic principles for tapering, such as expecting anxiety, insomnia, and resistance from patients and emphasizing education and support. For benzodiazepines, it recommends a slow taper by calculating the total daily dose and reducing it by 25-50% initially or 5-10% per week, monitoring the patient's response. For opioids, it suggests utilizing equivalent dosing charts and tapering by 5-15% per week, more slowly for longer-acting drugs and less stable patients.

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95 views1 page

Opioid-BenzosTapering Flowchart

This document provides a flowchart for tapering benzodiazepines and opioids. It outlines basic principles for tapering, such as expecting anxiety, insomnia, and resistance from patients and emphasizing education and support. For benzodiazepines, it recommends a slow taper by calculating the total daily dose and reducing it by 25-50% initially or 5-10% per week, monitoring the patient's response. For opioids, it suggests utilizing equivalent dosing charts and tapering by 5-15% per week, more slowly for longer-acting drugs and less stable patients.

Uploaded by

juanchibarberoism
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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TAPERING FLOWCHART

START HERE BENZODIAZEPINE TAPER


Consider opioid taper for patients with opioid MED > 120/methadone > 40, Basic principle: Expect anxiety, insomnia,
aberrant behaviors, significant behavioral/physical risks, lack of improvement in and resistance. Patient education and
pain and function. support very important. Risk of seizures with
abrupt withdrawal increases with higher
Consider benzodiazepine taper for patients with aberrant behaviors, behavioral
doses. The slower the taper, the better
risk factors, impairment, or concurrent opioid use.
tolerated.
1 Explain to the patient the reason for the taper: “I am concerned…”

2 Determine rate of taper based on degree of risk. 1 Slow taper: Calculate total daily
dose. Switch from short acting
3 If multiple drugs involved, taper one at a time (e.g., start with benzos, follow agent (alprazolam, lorazepam) to
with opioids). longer acting agent (diazepam,
clonazepam). Upon initiation of
4 Set a date to begin, provide information to the patient, and set up behavioral taper reduce the calculated dose
supports, prior to instituting the taper. See page 26 of OPG guidelines. by 25–50% to adjust for possible
metabolic variance.

2 First follow up visit 2–4 days after


initiating taper to determine need
OPIOID TAPER to adjust initial calculated dose.

3 Reduce the total daily dose by


Opioids (not methadone) Methadone
5–10% per week in divided doses.
Basic principle: For longer acting Basic principle: Very long half life
drugs and a more stable patient, use may necessitate a more protracted 4 After ¼ to ½ of the dose has been
slower taper. For shorter acting drugs, tapering process. Otherwise follow reached, with cooperative patient,
less stable patient, use faster taper. opioid principles. you can slow the taper.

MED for Selected Opioids 5 Consider adjunctive agents to


1 Utilize the drug the patient is taking help with symptoms: trazodone,
as the tapering medication. If you Approximate
Equianalgesic
buspirone, hydroxyzine, clonidine,
switch medications, follow MED antidepressants, neuroleptics, and
equivalency chart and then reduce Dose (oral and
Opioid transdermal) alpha blocking agents.
the dose by 25–50% as starting
dose. Metabolic variability can be Morphine (reference) 30mg
quite significant. Utilize a 90% dose Codeine 200mg
reduction if switching to methadone. 1 Rapid taper: See the tapering guidelines
Fentanyl transdermal 12.5mcg/hr on page 28 of the OPG guidance
See dose calculator link below.
Hydrocodone 30mg documents.
2 Decrease total daily starting dose by Hydromorphone 7.5mg
5–15% per week in divided doses. Methadone Chronic: 4mg†
Oxycodone 20mg
Benzodiazepine Equivalency Chart
3 See patient frequently during Half-life Dose
Oxymorphone 10mg Drug (hrs) Equivalent
process and stress behavioral
supports. Consider UDS, pill counts, Chlordiazepoxide
5–30 h 25mg
and PDMP to help determine (Librium)
adherence. Link to Morphine Equivalent Diazepam (Valium) 20–50 h 10mg
Dosing (MED) Calculator Alprazolam (Xanax) 6–20 h 0.5mg
4 After ¼ to ½ of the dose has been agencymeddirectors.wa.gov/mobile.html
reached, with cooperative patient, Clonazepam (Klonopin) 18–39 h 0.5mg
you can slow the process down. Lorazepam (Ativan) 10–20 h 1mg
Oxazepam (Serax) 3–21 h 15mg
5 Consider adjuvant medications: Triazolam (Halcion) 1.6–5.5 h 0.5mg
antidepressants, NSAIDs, clonidine,
anti-nausea, anti-diarrhea agents.
www.oregonpainguidance.com

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