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Complete Guide On Discontinuing Tapentadol -Tapering Opioids

Complete Guide On Discontinuing Tapentadol -Tapering Opioids

Chronic pain is one of the most prevalent reasons for medical assistance in the United States, with opioids such as Tapentadol commonly prescribed to treat this condition. In context to the risks of long-term opioid therapy, CDC outlines prescription guidelines to heighten awareness. The US Department of Veteran affairs states about 41% of patients with prolonged use of opioids will develop opioid use disorder (OUD) [1]. 

Abrupt discontinuation of Tapentadol and other opioids has been associated with severe withdrawal symptoms, uncontrolled pain, and psychological distress. Thus, the key question remains about how to stop the intake of Tapentadol in different populations safely. Therefore, most interdisciplinary pain clinicians emphasize tapering opioids before completing discontinuing them. 

But does tapering off opiates work? This monograph on ceasing Tapenatdol use will answer your question and give you an insight on safe ways to wear off opiates. 

 

What do Tapering opioids mean?

Tapering opioids involves gradually decreasing the dose of your pain medication to lower the occurrence of withdrawal symptoms. Tapering is advisable for people taking opioid analgesics for chronic pain for an extended period. It is done in various settings, including hospitals (inpatients) or at home (outpatients). However, outpatients require close monitoring by a physician over people undergoing treatment at medical facilities. 

Why Taper Off Opioids?

 

wearing-off-opioids

Image ref- Michael G. DeGroote National Pain Centre [2]

 

Using opioids has a high affinity towards abuse and addiction. Even when taken under a medical prescription, prolonged use of Tapentadol can cause dependency in the user. Over time, the human body gets used to the compound and may cause withdrawal signs when the administration is disrupted abruptly. These are also the frequently reported signs of opioid use disorder. 

Struggling with OUD can impact a user's mental and physical well-being and affect their finances, career, and relationships. Such people often face difficulties in managing their opioid intake and may not be able to stop even if they want to.  

Some potential reasons to opt for opioid tapering are [3]-

  • Serious adverse effects 

  • Nonadherence to the treatment plan

  • Signs of abuse

  • Lack of improvement in the condition 

  • If the patient requests to discontinue the opioid treatment, 

Who does it benefit?

People who should be often considered for tapering opioids are cancer patients and those with migraine and fibromyalgia. Cancer patients are more susceptible to a long-term risk of opioid therapy due to their prolonged use of opioid analgesics to treat various pain symptoms. However, neuropathic pain resulting from radiation and chemotherapy responds poorly to opioids. 

The frequency of OUD in cancer patients is similar to the general population, with about 7 to 10% of the total people on long-term opioid therapy. Thus, wearing off opioids will benefit such people, decreasing the risk of OUD and long-term complications [4]. 

Another group of the population at a higher risk of Tapentadol recreational use is after a surgical procedure. About 9 to 13% of patients undergoing surgeries are prescribed Tapentadol or other opioids for more than 90 days [4]. 

Clinical characteristics which affect Tapentadol tapering

 

CLINICAL-CHARACTERISTICS-WHICH-AFFECT-TAPENTADOL-TAPERING

 

People on short-term Tapentadol therapy (2 weeks or less) may not require tapering. Individuals react differently to tapering, making certain people more suitable and easy for the process. 

Some people with borderline personality are reluctant to change their course of treatment. Mentally abilities can make some patients hard to trust their physicians, making it challenging for doctors to monitor their progress. 

People with borderline personality have a lifetime risk of experiencing pharmaceutical opioid dependence. Patients with emerging opioid use disorder are also likely to resist tapering off their medication. Such people are 3 to 4 times more likely to relapse from abstinence [4]. However, tapering may still be successful in such people but with minimal number or proportions. 

Other psychiatric disorders such as anxiety, PTSD, and depression may also be associated with resisting tapering. Approximately 34% of patients with depression abandon tapering, and 32% resume long-term use by consulting other physicians or getting cheap Tapentadol online. Patients with depression are often given antidepressants as an adjunct with tapering for better results [4]. 

Individuals with chemical and substance abuse are at a greater risk of facing difficulty while tapering. Studies show that people who use tobacco are at three times the risk, and smokers have a five times higher risk of experiencing opioid use disorder [4]. 

Not sure if your medication is considered an opioid?

Tapentadol is an FDA-approved opioid analgesic; however, most people buying Tapentadol online without a prescription may be aware of it. Such dubiety may also arise in people taking other popular opioid medications. Some prevalent opioid drugs in the market today are-

  • Fentanyl (Actiq, Duragesic, Fentora)

  • Hydrocodone (Hysingla ER, Zohydro ER)

  • Oxycodone-acetaminophen (Percocet, Roxicet)

  • Hydrocodone-acetaminophen (Anexsia, Norco)

  • Oxycodone (OxyContin, Roxicodone)

You may consult your doctor to ensure if your pain medicine is an opioid or not. 

Tapentadol opioid taper plan calculator

The standard Tapentadol dose is 100mg recommended three to four times a day. It aggregates the total intake up to 300mg to 400mg daily. So, such people must taper off Tapentadol usage in the following way-

 

Tapentadol-tapering-off

Tapentadol-tapering-off-graph

 

It is crucial to note that this calculation for tapering of Tapenatadol is done for 400mg and may differ depending on the dose taken [5]. 

 

Note- You can calculate your tapering doses depending on the strength and the opioid analgesic by clicking on the reference below [5]. 

 

Principles of tapering opioids

The tapering mechanism is complex and more based on experience than scientific evidence. Some of the points to consider while prescribing detox for pain pill withdrawal are-

  • Take the complete medical history of the patient

  • Educate the patient about the benefits of tapering opioids 

  • Prepare them for the upcoming medical changes 

  • Evaluate the patient after each reduction of dose over a call or visit them in person

  • Watch for signs of depression, mood change, anxiety, and craving. 

  • Prescribe non-opioid analgesic

  • Use supportive therapy to avoid Tapentadol pain pill withdrawal. 

 

Tapentadol-tapering

 

Tapering rate and speed of dose reduction

The FDA suggests no optimal tapering rate. The standard tapering rate is ultra-rapid (in 7 days), rapid (in 3 to 4 weeks), and slow, which may take months. Studies indicate that 25% of the dose taken the previous day helps prevent pain pill withdrawal symptoms. These calculations are based on the patient's total daily dose and are often individualized.

Ultra-rapid tapering often results in sedation and requires hospitalization. It is usually not the first choice by most physicians and is prescribed when a peripheral block reduces pain, causing severe opioid toxicity in the patient. The need for ultra-rapid tapering is infrequent, and in most cases, tapering can be done over a month or longer, depending on the patient's condition. 

Rapid and slow opioid tapering is physicians' most recommended opioid tapering method. This approach is safe and does not usually require hospitalization or medicine to treat withdrawal signs. A clinical trial involving 1728 patients reports safe withdrawal from opioids for 1 to 2 weeks. Most clinicians were able to decrease the opioid dose rate up to 50% per day. 

 

Tapentadol dose Reduction-

Tapentadol is a highly tolerant opioid analgesic making it a much safer option in the market. While lowering your dosage, it is best to consult a physician to avoid all possible adverse effects and withdrawal symptoms. 

The key factors to consider while tapering off Tapenatdol pain medication are [6]-

  • The dual mechanism of action of Tapentadol may make it challenging to reduce. For Tapentadol, most physicians recommend the “see-sawed” reduction option. Here, the physician divides the dosage into two halves- morning and evening.

  • People who find it hard to reduce their Tapentadol 100mg dose can convert to oral morphine.

  • The pain medicine facility advises patients to reduce Tapentadol intake by no more than 10% every 1 to 2 weeks. 

5 steps to opioid tapering

 

Step 1- Study the patient's expectations

Since our topic of interest is Tapentadol tapering, let us take this opioid analgesic in the scenario. While exploring a patient's readiness to lower their dose, the physician must address their treatment expectation and concerns. 

A clinician can assess a patient by incorporating the "5 As" questionnaire.  

  1. Analgesia- How will you rate the pain? How much relief is your opioid providing?

  2. Activity- Are you able to achieve your functional goals?

  3. Adverse effects- Are you experiencing any side effects from the opioid?

  4. Affect- Is your analgesic causing any mood changes?

  5. Aberrant behavior- Are you taking your dose as prescribed? Or have you increased or decreased your dose lately? 

 

Step 2- Review pain management plans

When the dose of the pain medicines reduces, patients might experience intense pain. Therefore, effective pain management will help set meaningful goals for self-management. These can be

  • Cognitive behavioral therapy (CBT)

  • Physical therapy

  • Mindful interventions. 

Ensure to provide primary care and allied health professionals for complete pain management. Multidisciplinary pain management addresses several aspects of chronic pain, thus helping reduce pain intensity and improve mood. 

 

Step 3- Develop a tapering plan

When the patients agree to reduce their dose, developing a tapering plan is a primary goal. It should be made taking the patient's expectations, circumstances, and preferences into consideration.

 

Step 4- Expecting some withdrawal symptoms

Withdrawal signs while tapering is often visible with a rapid or sudden decrease in the dose. Opting for a gradual approach with regular appointments with a physician for follow-up can minimize the risk. 

 

Step 5- Seek support

Tapering can be challenging, and often patients wish to give up and suffer from relapse. The key reasons most people drop out of the tapering schedule are severe body pain, depression, and opioid use disorder. People at higher risk of dropping out should seek medical assistance to manage their conditions. 

Manage withdrawal symptoms during Tapentadol tapering

For managing the signs of Tapentadol withdrawal, using short-term oral medications is advisable. Guidelines recommend that 0.1 to 0.2 mg of clonidine every 6 hours until the taper is complete can help. Enrolling in supportive therapy, too, is very effective in assisting such concerns. However, treating withdrawal signs with benzodiazepine or other opioids is not advisable.

  • The physical withdrawal symptoms usually resolve within 5 to 10 days of dose reduction.

  • It may cause psychological withdrawal symptoms such as insomnia and dysphoria.

However, most of these symptoms may not appear with medical tapering. 

Medicines used to manage opioid withdrawal

 

Indication

Treatment options

Autonomic symptoms (myoclonus, sweating, tachycardia)

First line:

Clonidine 0.1 to 0.2 mg every 6 to 8 hours. Hold the dose if blood pressure is <90/60 mmHg. 

 

Alternatives:

Take Baclofen 5 mg 3 times daily. One may increase to 40 mg 

Myalgias

Acetaminophen 650 mg every 6 hours

NSAIDs, ibuprofen. 

Dysphoria, anxiety

Hydroxyzine 25 to 50 mg three times a day, or Diphenhydramine 25 mg every 6 hours 

Sleep disorder

Trazodone

Diarrhea

Bismuth subsalicylate, and Loperamide

Nausea

Ondansetron, Prochlorperazine and Promethazine

 

Home detox from opiates

 

Home-detox-from-opiates

 

Withdrawal symptoms and dependency is ubiquitous in people abusing opioid pain medicines. The body of such people is used to having the compound, thus making it hard to stop its intake. Along with tapering and using an adjunct medication, several potential home remedies can help with the condition.  

 

Try to stay comfortable and safe-

Often, people who have gone through withdrawal or have undergone tapering recommend staying comfortable. Keeping the mind occupied can help. Try to use soft blankets and extra sheets to make yourself cozy. 

 

Acupuncture-

It is an ancient Chinese technique of using needles in specific body parts to help restore the energy flow. Several studies signify the effectiveness of acupuncture during a detox. It can be used in conjugation with your medicines and therapy. 

 

Exercise or fitness programs-

Fresh air and sunlight can be effective and soothing for your mental and physical well-being. Exercise and fitness regime helps in the production of endorphins that assists in lowering opioid abuse. Physical activities also provide stimulation and aid in stress relief. A study in the Frontiers in Psychiatry journal indicates that exercising can help prevent relapse and minimize drug craving in users.

Tapentadol tapering recommendations from various organizations

The timeline of tapering Tapentadol varies in people. The following are the tapering recommendations by several organizations [7]-

The Department of Veterans Affairs and the Department of Defense-

Slow dose reduction of 5 to 20% every four weeks.

For faster tapering- daily reduction of 20 to 50%.

 

Mayo clinic-

For chronic users- decrease the dose to 10% every 5 to 7 days until 30% of the original dose is reached. Follow this by a weekly decrease of 10%.

 

CDC-

For chronic users- 10% decrease in the dose per week. 


FAQ's

Yes, your primary care physicians can prescribe your tapering schedule.

Several pieces of research establish that high doses of opioids are not as safe as physicians once believed. Your doctor or care team may ask you to taper-

  • A lower dose of the analgesic may relieve pain

  • To lower the risk of side effects

  •  If you are experiencing severe pain even after administering a high dose of the analgesic.

The benefits of opioid tapering include making the patient more alert. It helps you achieve a stable mood. Such people are also in more control over their life.

No, it is not advisable for one to self-taper. Such people should consult their physician before making any changes to their dosage. You need to get in touch with your physician and create a tapering plan tailored to your needs.

The time needed to get off opioids completely will depend on your dosage and rate of dosage reduction. On average, it may take around a few weeks to a month.

When tapering off your medicine, you will need regular checkups with your physicians. In these appointments, the doctor will monitor your vital signs and blood pressure and also check your progress. Your physician may also suggest blood or urine tests to check the drug level in your system.

In your tapering process, you can seek help from a mental health professional or even join a support group for help and assistance.

Yes, several pieces of evidence suggest the effective result from tapering. However, the time frame required by each individual to show positive results may differ.


References-

  1. Tapering opioid therapy: clinical strategies, futuremedicine. 

  2. Opioid Tapering, Michael G. DeGroote National Pain Centre. 

  3. Tapering Resource, aafp.org.

  4. Tapering opioids: a comprehensive qualitative review, amegroups. 

  5. Taper Calculator, paindata.org. 

  6. Tapentadol suggested tapering regime, somerset drug & alcohol service. 

  7. Safe opioid storage, tapering, and disposal, asra.