How to taper off medications safely

Prescription medications can help you manage different health conditions for a given period of time. When you have completed your treatment, your healthcare professional may advise you to taper off your medication. They may also recommend this when switching you to a new drug.

What does it mean to taper medication?

Tapering medication involves gradually reducing or weaning off your prescribed drug dose under a healthcare professional’s guidance. 

Doctors typically recommend tapering medication when switching to a new maintenance dose or discontinuing a drug altogether.

Tapering involves a slow and steady approach to minimize or prevent withdrawal symptoms. A doctor may recommend tapering when you’ve been on a medication for a long time, or when you take specific medications your body tends to get used to. By weaning off the drug, your body slowly adapts to functioning without it.

What drugs need tapering?

Not all medications require tapering. However, some drugs require this method to prevent severe and potentially dangerous withdrawal effects.

If you wish to discontinue any long-term medication, it’s best to consult your prescribing healthcare professional first to ensure it is safe to stop taking it. They can advise you on which gradual approach to take or whether you may stop the medication without tapering. 

Your healthcare professional is the best source of information regarding medications you take that need tapering. Their decision on when and how to taper a medication may depend on different factors.

Some examples of medications you may need to taper off include: 

Opioids

Clinical guidelines from 2019 emphasize the importance of tapering opioid medications slowly.

Not tapering opioids may lead to severe withdrawal symptoms, including:

• nausea
• vomiting
• muscle aches
• insomnia
• cravings for the medication
• severe pain
• chills

Opioid medications may include:

• morphine sulfate controlled-release tablets (MS Contin)
• oxycodone (OxyContin)
• fentanyl (Duragesic)

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Psychotropic medications

Drugs prescribed to treat mental health conditions may require tapering, particularly benzodiazepines.

Suddenly stopping psychotropic medications may lead to the following symptoms:

• changes in mood
• anxiety
• insomnia
• hallucinations (seeing, feeling, hearing, or smelling things that aren’t actually there)
• seizures

Examples of drugs that need slow and careful tapering include:

• antidepressants:
  • selective serotonin reuptake inhibitors, like escitalopram (Lexapro) or fluoxetine (Prozac)
  • monoamine oxidase inhibitors, such as phenelzine (Nardil) or selegiline (Emsam)
  • serotonin-norepinephrine reuptake inhibitors, like duloxetine (Cymbalta) or venlafaxine (Effexor)
• antipsychotics:
  • phenothiazines, like fluphenazine or perphenazine
  • thioxanthenes, such as thiothixene
• benzodiazepines:
  • alprazolam (Xanax)
  • diazepam (Valium)
  • lorazepam (Ativan)

Steroids

Doctors may prescribe corticosteroids for the long-term treatment of conditions like asthma and autoimmune disorders.

You may need to taper off oral steroids to avoid adrenal insufficiency, fatigue, and joint pain.

Corticosteroid medications include:

• prednisone (Rayos)
• triamcinolone
• dexamethasone

Antiepileptic drugs

A review from 2022 highlights the need to taper off seizure medications to prevent seizures or worsening of the underlying condition.

Some of these medications are:

• gamma-aminobutyric acid analogs, like gabapentin (Neurontin) or pregabalin (Lyrica)
• dibenzazepine anticonvulsants, such as carbamazepine (Carbatrol) or oxcarbazepine (Trileptal)
• pyrrolidine anticonvulsants, like levetiracetam (Keppra) or brivaracetam (Briviact)

Beta-blockers

Tapering off beta-blocker medications for high blood pressure or heart conditions is encouraged.

This may help avoid rebound hypertension (high blood pressure), heart rate fluctuations, and heart attacks.

Beta-blockers include:

• propranolol (Inderal)
• carvedilol (Coreg)
• metoprolol (Lopressor, Toprol XL)

Attention deficit hyperactivity disorder (ADHD) stimulant medications

You may need to taper certain ADHD stimulant medications. Otherwise, you may experience withdrawal symptoms like:

• fatigue
• irritability
• anxiety
• depression

ADHD stimulant medications that may need tapering include:

• methamphetamine (Desoxyn)
• amphetamine dextroamphetamine (Adderall)
• methylphenidate (Ritalin)
• lisdexamfetamine (Vyvanse)

How do you safely taper off a medication?

It’s important to work with a healthcare professional to taper off medication. They can assess your health and medical condition, consider alternatives and risks, and provide a tapering method.

Here are some general steps they may recommend:

• A slow and steady pace: Tapering involves gradually reducing the dosage over days, weeks, or months. The speed depends on the medication and your overall health. For example, the clinical guidelines from 2019 referenced above explain that reductions in opioid dosage may be as little as 5% every 4 weeks. 
• Close monitoring: During tapering, the healthcare professional you work with will closely monitor your progress. They’ll adjust your tapering plan as necessary to help manage any symptoms.
• Lifestyle adjustments: In some cases, lifestyle modifications or alternative therapies may help ease the transition. For example, regular physical movement and changes to your diet may help reduce symptoms such as changes in mood or fatigue. 
• Emotional support: You can seek emotional support from friends, family, or support groups if dealing with withdrawal symptoms. 
• Different therapies: The 2023 paper referred to above suggests that some people may benefit from talk therapy, like cognitive behavioral therapy, when stopping certain medications. 

Are withdrawal symptoms still possible when tapering?

Even with a carefully planned taper, withdrawal symptoms may occur. Working closely with a healthcare professional may help you manage them. 

The severity and types of withdrawal symptoms may vary depending on factors such as: 

• the type of medication
• how long you’ve been taking the medication
• the strength of the dose you’ll taper from
• the pace of the tapering plan
• any underlying conditions you may have

According to the references listed above — including the clinical guidelines from 2019, the 2022 systematic review, and the 2023 paper — withdrawal symptoms may present as:

• anxiety or panic attacks
• insomnia
• nausea or vomiting
• sweating
• muscle aches and pain
• mood changes
• irritability
• headaches
• cravings
• fatigue

These symptoms are usually temporary and gradually subside as your body adjusts to less medication.

What to ask your doctor about tapering medication

When discussing tapering with your healthcare professional, you may want to ask about anything that concerns you. 

Questions could include: 

• Why is tapering necessary for this medication?
• What is the tapering plan, including the duration and dosage adjustments?
• What withdrawal symptoms should I expect, and how can I manage them?
• Are there any potential risks or complications during the tapering process?
• What alternative treatments or lifestyle changes can help during and after the tapering process?
• What support options are available to me during this process?

Summary

Tapering a medication means slowly reducing the dosage so your body adjusts to working without the drug. A slow tapering process may help ensure your health, safety, and well-being. 

It’s essential to work closely with a healthcare professional to create a personalized tapering plan that minimizes withdrawal symptoms. They can also recommend other support options like therapy or lifestyle changes to make you feel your best during tapering.