Adjuvants
For children who have been taking adjuvants for longer than 2 weeks, seek specialist advice for a deprescribing schedule.
There is limited evidence to guide adjuvant deprescribing. For adults, an approach to adjuvant deprescribing for chronic noncancer pain is:
- if the patient has been taking the adjuvant for less than 3 months, reduce the dose by 25 to 30% every week
- if the patient has been taking the adjuvant for longer than 3 months, reduce the dose by 25 to 30% every 2 weeks.
See Examples of adjuvant deprescribing for examples of adjuvant deprescribing.
Example 1
Original dose: A patient has been taking amitriptyline 100 mg orally at night, for the past 2 months.
Calculation: 25% of the original daily dose is 25 mg; dose reductions will be 25 mg every week.
Deprescribing regimen:
amitriptyline 75 mg at night for 1 week, then
amitriptyline 50 mg at night for 1 week, then
amitriptyline 25 mg at night for 1 week, then
stop.
Example 2
Original dose: A patient has been taking gabapentin 400 mg orally, three times a day for the past 12 months.
Calculation: 25% of the original daily dose is 300 mg; dose reductions will be 300 mg daily every 2 weeks.
Deprescribing regimen:
gabapentin 300 mg three times a day for 2 weeks, then
gabapentin 300 mg twice a day for 2 weeks, then
gabapentin 300 mg once a day for 2 weeks, then
stop.