For those on a higher dose and/or longer term opioids there is an increased potential for more challenges to tapering, including withdrawal symptoms.
Example of slow taper
Current opioid: Morphine SR 120mg bid
- Calculate total opioid dose: Total Daily Morphine Dose = 240mg/d
- Calculate daily opioid dose – typically 5–10%
- 5% = 12mg
- 10% = 24mg
- Reduce the dose every 2 to 4 weeks depending on how the patient is tolerating the taper and their desire to taper
Example:
Decrease Morphine SR by 15 mg
- Weeks 1 & 2 Morphine SR 105mg qam and 120mg qhs
- Weeks 3 & 4 Morphine SR 105mg bid
- Weeks 5 & 6 Morphine SR 90mg qam and 105mg qhs
- Weeks 7 & 8 Morphine SR 90mg bid
- Weeks 9 &10 Morphine SR 75mg qam and 90mg qhs
- Weeks 11 & 12 Morphine SR 75mg bid
- Weeks 13 & 14 Morphine SR 60mg qam and 75mg qhs
- Weeks 15 & 16 Morphine SR 60mg bid
- Weeks 17 & 18 Morphine SR 45mg qam and 60mg qhs
- Weeks 19 & 20 Morphine SR 45mg bid
- Continue until the lowest effective dose is found for the patient.
NOTE: Lowest available Morphine SR formulation is 15mg tablet or Morphine ER 10mg capsule
Slow taper tips
- Tapering reductions can be lower than 5% if gentler reductions are needed. For q24h formulation a gentler taper option is to reduce the dose by 10mg increments every 2 weeks.
- For patients with no acute safety concerns (e.g. 5–10% of MED every 2–4 weeks),1 tapers might need to be slowed once low dosages have been reached. Once the smallest available dose is reached, the interval between doses can be extended. Opioids may be stopped when taken less frequently than once a day.3