Opioids
For children who have been taking opioids for longer than 2 weeks, seek specialist advice for a deprescribing schedule.
For adults, a standard approach to opioid deprescribing for chronic noncancer pain is:
- if the patient has been taking the opioid for less than 3 months, reduce the dose by 10 to 25% every week
- if the patient has been taking the opioid for longer than 3 months, reduce the dose by 10 to 25% every 4 weeks.
If necessary, the rate of dose reduction can be slower (eg while awaiting psychological therapy). A faster dose reduction can be considered if adverse effects are intolerable or opioid misuse is suspected—seek specialist advice. See Examples of opioid deprescribing for examples of opioid deprescribing.
For a printable deprescribing plan for patients, see the NPS MedicineWise website.
For conversation starters for prescribers to discuss opioid deprescribing or dose reductions with patients, see the NPS MedicineWise website.
Example 1
Original dose: A patient has been taking tramadol modified-release 100 mg orally, twice daily (ie 200 mg per day) for the past 2 months.
Calculation: 25% of the original daily dose is 50 mg; dose reductions will be a maximum of 50 mg every week.
Deprescribing regimen:
tramadol modified-release 50 mg in the morning and 100 mg at night for 1 week, then
tramadol modified-release 50 mg in the morning and 50 mg at night for 1 week, then
tramadol modified-release 50 mg at night for 1 week, then
stop.
Example 2
Original dose: A patient has been taking oxycodone modified-release 40 mg orally, twice daily (ie 80 mg per day) for the past 12 months.
Calculation: 25% of the original daily dose is 20 mg; dose reductions will be a maximum of 20 mg (ie 10 mg twice daily) every month.
Deprescribing regimen:
oxycodone modified-release 30 mg twice daily for 1 month, then
oxycodone modified-release 20 mg twice daily for 1 month, then
oxycodone modified-release 10 mg twice daily for 1 month, then
oxycodone modified-release 5 mg twice daily for 1 month, then
stop.