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 (withdrawal):
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.