“How to taper off medication” is a question that I have been asked on a frequent basis.  Honestly, it is a really challenging question to address and the answer of “it depends” certainly applies.  Here’s a few factors that you must think about when making recommendation about tapering off medications.

1. Length of use.  If a patient has been on a medication for a really long time and it took some titrating up to get to their current dose, a taper is likely going to be appropriate in the absence of a really severe or life-threatening interaction.
2. Drug.  The medication you are tapering off matters.  Are we looking at a constipation medication, an antipsychotic, an opioid, or a beta-blocker?  Depending upon the medication we will likely need to be more or less cautious about the rate of reducing the dose and tapering off.
3. Dose.  Are we using omeprazole 40 mg BID, or MS Contin 60 mg BID?  Then we will likely want to not just discontinue this medication without tapering.  Failure is likely inevitable without tapering in those two examples.
4. Reason for discontinuing.  Are we just trying to reduce polypharmacy?  Then we don’t need to have the patient off the medication in the next week.  Think about the reason why we are getting off the medication and this should help guide your urgency and frequency of reduction.
5. Are we starting a medication with similar pharmacodynamic action?  Are we converting between antidepressants, then we can possibly get a little more aggressive in the timeframe, recognizing that the new drug will help prevent withdrawal type symptoms.
6. Half-life.  How quickly a drug is eliminated from the body may impact the requirements for tapering.  A drug with an extremely long half life will tend to have a self tapering effect.

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