Drug tapering is an important process to discontinue a prescription medication or drug detox from certain substances. The taper allows the body to wean off the drug and adapt gradually, reducing the severity of withdrawal symptoms and possible complications.
Find out what drug tapering means, how to taper off drugs safely, always under the supervision of a healthcare provider, and some guidelines that physicians may use for tapering some drugs.
A drug taper is a gradual reduction of a drug’s dosage over time.[1] This is always done under the guidance of a doctor. Instead of stopping a drug “cold turkey,” tapering helps the body and brain readjust to functioning without the drug.
The goal of a taper is to prevent withdrawal symptoms or reduce their severity. Tapering can also avoid rebound effects, which are symptoms of the condition being treated returning, often worse than they were before drug treatment. Some drugs have intense withdrawal syndromes that can cause complications like seizures or blood pressure spikes, but a drug taper can reduce the likelihood of these health risks.
In drug detox, tapering should be used in combination with medical monitoring and medications to help with withdrawal symptoms.
Stopping certain drugs abruptly can cause serious, possibly life-threatening reactions. Many drugs alter brain chemistry by changing how neurotransmitters and receptors function.[2] Over time, the body becomes physically dependent on the drug to function, leading to withdrawal symptoms if it’s stopped suddenly. Symptoms vary based on the drug involved, but can include seizures or psychosis. A safe taper allows the brain and body to adjust and “reset” gradually, reducing these risks.
There are several types of drug tapers, but they’re not all appropriate for every situation.
Tapering is not a one-size-fits-all process. A safe and effective taper plan depends on the drug being discontinued, the dosage and duration of use, your health history and current condition, and your history of withdrawal reactions.
Always consult a doctor or medical professional. You shouldn’t try to taper your dose on your own. A doctor can design a taper schedule based on the drug type and your individual health.
Many drug taper schedules reduce the dose every 1 to 4 weeks, but the schedule may be adjusted based on your response and the withdrawal symptoms you experience. In some cases, the taper may need to be slowed or paused if the symptoms become severe.
Drug taper schedules are often used to wean psychiatric medications, but they’re also used for drug detox and addiction treatment. A taper may be used alongside counseling and therapy, possibly with medications to relieve some withdrawal symptoms.
Some drug classes have recommended taper schedules for medical professionals. These are general guidelines based on responsible research and previous evidence of drug withdrawal in many patients.. None of this should be taken as a substitute for medical advice. Always follow your doctor’s recommendations for drug tapering.
Benzodiazepines like lorazepam, alprazolam, and diazepam are known for causing withdrawal symptoms if they’re discontinued abruptly. Some of the withdrawal symptoms can be severe, such as panic attacks, seizures, and hallucinations.
According to the American Society of Addiction Medicine and several other medical associations, physicians may prescribe benzodiazepine dosage reduction over 2 to 4 weeks, but never more than 25% of the previous dose.[3] Another possible prescription is the Ashton Method, which promotes gradual reduction in small increments over a long period.[4] In some cases, short-acting benzodiazepines may be switched to a long-acting benzodiazepine like diazepam, then tapered over several months.
Opioids like morphine, oxycodone, hydrocodone, and fentanyl are used both medically and illicitly. Though withdrawal can be intense, it’s not usually life-threatening. However, severe flu-like symptoms can cause complications, and distressing psychological symptoms like anxiety and insomnia can increase the risk of relapse.
Generally, opioid doses are reduced gradually, over 1 to 3 weeks, adjusting the taper pace to the severity of symptoms.[5] With short-acting opioids, withdrawal begins in 6 to 12 hours and lasts several days to a week or longer.[6] With extended-release opioids, withdrawal starts about 24 to 48 hours after the last dose and can last 10 to 20 days.[7]
A drug taper can help with opioid withdrawal, but medications like methadone, buprenorphine, and clonidine may also be used to ease withdrawal symptoms during tapering.
Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, serotonin norepinephrine reuptake inhibitors (SNRIs) like venlafaxine, and tricyclic antidepressants (TCAs) like amitriptyline are not viewed as addictive drugs, but they can cause physical dependence and distressing withdrawal symptoms. Withdrawal usually begins within 3 days of stopping the drug and can last from weeks to months, often with flu-like symptoms, dizziness, mood swings, and “brain zaps,” or electric shock-like sensations.
Generally, antidepressant dosage is gradually reduced over weeks or months, depending on the specific drug and dose, and adjusted as needed to relieve withdrawal symptoms.[8] .
Antipsychotic drugs like haloperidol, risperidone, and quetiapine are not viewed as addictive, but dependence can occur. Suddenly stopping antipsychotic use can cause withdrawal dyskinesia (involuntary or jerky movements), rebound psychosis, insomnia, and anxiety.
Generally, antipsychotics are tapered with a dose reduction over the course of a month or more.[9] After long-term use, extremely slow tapers that last several months may be used to avoid serious psychiatric symptoms.
Muscle relaxants like cyclobenzaprine, carisoprodol, and baclofen can cause dependence with long-term use. Abruptly stopping these drugs can cause severe withdrawal symptoms like anxiety, tremors, hallucinations, or severe rebound spasticity and seizures.
Generally, muscle relaxants should be gradually reduced over 1 to 2 weeks for short-term use.[10] With long-term or high dosage use, the taper may need to be done more slowly and adjusted regularly to reduce withdrawal symptoms.
Corticosteroids like prednisone, dexamethasone, and hydrocortisone are not drugs of abuse, but regular use suppresses the hypothalamic-pituitary-adrenal (HPA) axis. Stopping suddenly can trigger adrenal insufficiency, which can be life-threatening.
Generally, corticosteroids should be reduced by a nominal amount every 1 to 2 weeks.[11] For long-term or high-dose use, the taper can last months. Sometimes doses are held for a period of time to allow adrenal function to recover.
Tapering should only be attempted under the guidance of a physician as they prescribe. These examples give you an idea of what to expect when working with a physician, not what to do. This is not a substitute for medical advice.
Drug tapering with some drugs may be appropriate with only a doctor’s guidance, but others may require inpatient medical detox, a structured, supervised program that provides a medical team to manage symptoms and prevent complications. While this may include a taper schedule, medical detox offers comprehensive support and care for severe or dangerous withdrawal syndromes.
Medical detox may be recommended if the drug has a high risk of serious withdrawal symptoms and complications, such as benzodiazepines and alcohol, which can cause life-threatening seizures. If you’ve had tapers fail in the past or experienced severe withdrawal, use multiple substances, or have a co-occurring disorder, the supervision and medical monitoring of detox can provide a safer and more comfortable detox experience.
Keep in mind that medical detox is not a replacement for long-term treatment in the case of drug addiction, however. It’s helpful for withdrawal and builds a strong foundation for drug addiction treatment with a combination of therapies, counseling, peer support, and long-term relapse prevention skill building.
Tapering off any drug, especially drugs that cause dependence or intense withdrawal, should be gradual and monitored by a doctor. If you want to stop taking a drug, talk to your doctor about a taper schedule, and if necessary, medical detox and drug rehab.
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