Opioid Taper Calculator

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Caution: This calculator is intended for use as a starting point for tapering chronic opioid therapy regimens. Patients on methadone, buprenorphine or other complicated regimens, or who have significant comorbid mental health disorders should be referred for specialist consultation. In general, the rate of taper is 10% of total initial MED per week. However, the rate and duration of taper may be adjusted due to available opioid strengths, or based on the patient’s response. Do not reverse the taper; rate may be slowed or paused while monitoring for and managing withdrawal symptoms. Also, watch for signs of unmasked mental health disorders during taper, especially in patients on prolonged or high dose opioids.

Treatment of Opioid Abstinence Syndrome (withdrawl):

• Restlessness, sweating, or tremors: Clonidine 0.1-0.2mg orally every 6 hours or transdermal patch 0.1-0.2mg weekly during taper. If patch is used, oral medication may be needed for the first 72 hours. Monitor for hypotension and anticholinergic side effects.
• Nausea: Antiemetics such as ondansetron or prochlorperazine
• Diarrhea: Loperamide or antispasmodics such as dicyclomine
• Muscle pain, neuropathic pain or myoclonus: NSAIDs, gabapentin or muscle relaxants such as cyclobenzaprine, tizanidine or methocarbamol
• Insomnia: melatonin or sedating antidepressants (e.g. mirtazapine 15mg or trazodone 50mg at bedtime). Do not use benzodiazepines or sedative-hypnotics.

Step 1 Instructions:

Fill in the mg per day* for whichever opioids your patient is taking. You can input up to two short acting opiates, and one long acting opiate. The web page will automatically calculate the taper schedule with target dates.

Patient's Name: Start Date:

Step 1: Initial Total Dose
Opioid Type:	Baseline Opioid	mg/dose*	Doses/day	Current mg/day:*	Morphine equivalents:	% of Total
Short Acting Opiate:	Select Opiate	Select Dose	Dose Per Day
Long Acting Opiate:	Select Opiate	Select Dose	Dose Per Day
Total					0	0

*NOTE: All doses expressed in mg per day with exception of fentanyl transdermal, which is expressed in mcg per hour

Step 2 Instructions: Taper short acting opioid(s)

SAO1 Variable
Day of Taper	Total mg/day
varSAO1Day1	varSAO1Day1Dose

This opioid taper calculator was developed by the Washington State Agency Medical Directors' Group to be used in conjunction with the Interagency Guideline on Prescribing Opioids for Pain. For more info, please refer to the guideline at: AMDG - 2015 Guidelinehttp://www.agencymeddirectors.wa.gov/guideline.htm

For technical questions or comments, please contact: AMDG Web SupportAMDG IT Support at wisj235@lni.wa.gov. Please note: this calculator is not compatible with IE 7 or below.