Features and overview

Rapid Taper is done over days. Rapid tapers can cause withdrawal effects and patients should be treated with adjunctive medications to minimize these effects; may need to consider admitting the patient for inpatient care. If patients are prescribed both long-acting and short-acting opioids, the decision about which formulation to be tapered first should be individualized based on medical history, mental health diagnoses, and patient preference. Data shows that overdose risk is greater with long-acting preparations. In rapid taper, reduce opioid by 20 to 50% of first dose if needed, then reduce by 10 to 20% every day. An example of the rapid taper is given below. During the first day in the rapid taper, 33% reduction of morphine SR 90 mg Q8h = 270 MEDD consists of 60 mg SR (15 mg x 4) Q8h. The subsequent daily dosage for the rapid taper is 45 mg SR (15 mg x 3) Q8h for day 2, 30 mg SR (15 mg x 2) Q8h for day 3, 15 mg SR Q8h for day 4, 15 mg SR Q12h for day 5-7, 15 mg SR QHS for day 8-11. Stop rapid tapering after day 11 and may consider morphine IR 15 mg ½ tablet (7.5 mg) twice daily.

Question: How long does the rapid taper take?
Answer: over days

Question: How much opioid to reduce in the rapid taper?
Answer: by 20 to 50% of first dose if needed, then reduce by 10 to 20% every day

Question: During the first day in the rapid taper what does consist of 33% reduction of morphine SR 90 mg Q8h = 270 MEDD?
Answer: 60 mg SR (15 mg x 4) Q8h

Question: When reducing 33% of morphine SR 90 mg Q8h = 270 MEDD on day 1, what dose should be taken on day two of the rapid opioid tapering?
Answer: 45 mg SR (15 mg x 3) Q8h

Question: When reducing 33% of morphine SR 90 mg Q8h = 270 MEDD on day 1, what dose should be taken on day three of the rapid opioid tapering?
Answer: 30 mg SR (15 mg x 2) Q8h

Question: When reducing 33% of morphine SR 90 mg Q8h = 270 MEDD on day 1, what dose should be taken on day four of the rapid opioid tapering?
Answer: 15 mg SR Q8h

Question: When reducing 33% of morphine SR 90 mg Q8h = 270 MEDD on day 1, what dose should be taken on day five of the rapid opioid tapering?
Answer: 15 mg SR Q12h

Question: When reducing 33% of morphine SR 90 mg Q8h = 270 MEDD on day 1, what dose should be taken on day six of the rapid opioid tapering?
Answer: 15 mg SR Q12h

Question: When reducing 33% of morphine SR 90 mg Q8h = 270 MEDD on day 1, what dose should be taken on day seven of the rapid opioid tapering?
Answer: 15 mg SR Q12h

Question: When reducing 33% of morphine SR 90 mg Q8h = 270 MEDD on day 1, what dose should be taken on day eight of the rapid opioid tapering?
Answer: 15 mg SR QHS

Question: When reducing 33% of morphine SR 90 mg Q8h = 270 MEDD on day 1, what dose should be taken on day nine of the rapid opioid tapering?
Answer: 15 mg SR QHS

Question: When reducing 33% of morphine SR 90 mg Q8h = 270 MEDD on day 1, what dose should be taken on day ten of the rapid opioid tapering?
Answer: 15 mg SR QHS

Question: When reducing 33% of morphine SR 90 mg Q8h = 270 MEDD on day 1, what dose should be taken on day eleven of the rapid opioid tapering?
Answer: 15 mg SR QHS

Question: When to stop rapid tapering?
Answer: after day 11

Question: What may be considered after stopping rapid tapering after day 11?
Answer: morphine IR 15 mg ½ tablet (7.5 mg) twice daily

Question: Which taper can cause withdrawal effects?
Answer: Rapid tapers

Question: What can be caused by rapid taper?
Answer: withdrawal effects

Question: How to minimize withdrawal effects in patients caused by rapid tapers?
Answer: patients should be treated with adjunctive medications

Question: What may need to be considered during rapid tapers?
Answer: admitting the patient for inpatient care

Question: If patients are prescribed both long-acting and short-acting opioids, the decision about which formulation to be tapered first should be individualized based on what?
Answer: medical history, mental health diagnoses, and patient preference

Question: When to take individualized decisions about which formulation to be tapered first?
Answer: If patients are prescribed both long-acting and short-acting opioids