Inpatient Medication Tapering

Alternative to Meds Editorial Team
Medically Reviewed by ATMC Clinical Review Team

After thousands of residential patients, we are highly aware of all available tapering techniques and are qualified to discuss the strengths and potential limitations of each.

We can firmly say this:  Abrupt cessation of medication is almost always a poor approach, as are rapid detox methods.

The body is a delicate and complicated instrument, and unless medically warranted, it is ill-advised to suddenly stop a medication. The body needs time to adjust to the neuroadaptation that occurs in response to these medications. This is particularly true regarding antidepressants, benzodiazepines and antipsychotics, and even more so when the medication has been in use for a longer duration. We implore the community at large to understand that rapid detox is a gamble despite being favored by the insurance companies.

Alternative to Meds Center is not a rapid detox facility because it almost never works as promised by those promoting the practice. It is a lot easier for ATMC to accept and help someone who is reasonably stable than it is to receive someone who has been fractured and rendered truly unstable by abrupt rapid-detox methods. The following is a brief summary of various tapering techniques that can be used, followed by a more expanded description for each further below in this article.

Methods for Medication Withdrawal may include:

• Direct tapering
• Pill cutting
• Medication crossover
• Substitution tapering
• Interdosing withdrawal
• Bridge medications

What is Tapering?

Medication tapering is a slow reduction method that allows time for the body to adjust to each new level. We find tapering is definitely more effective than any form of cold-turkey or rapid detox, even with those that include comfort medications.

This work is not easy, and it takes precision and experience to know which drugs to taper first and how, but also how to support this process on a natural physiological level as well as an emotional level. Each medication tapering protocol is a precise process, requiring discernment. We cannot be more clear about that. If we could give away all of the information that would work for everyone, we would. However, medication tapering is highly specific to each person, and that is exactly what has made Alternative to Meds successful; individualized protocols. These techniques are not something that could be broadly standardized or a single methodology that could be patented. Alternative to Meds residential program tapering protocols will include all of the prescribing needs and the tapering methods selected are based on individual factors, using the participant as the final voice in the process.

Below is more general information for the tapering community at large.

Which medication should I taper first?

Each case is truly unique, but here we present some general guidelines. The below is for information only and is not to be considered medical advice. Medical advice should only be given to you by a doctor or nurse practitioner with whom you have had face-to-face contact, or minimally, an established telemedicine relationship.
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Drug Tapering Methods and Strategies

Pill Cutting Method

This method involves simply cutting the pills themselves into smaller doses. Each medication has its own set of precise and most effective techniques.
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Inpatient Medication Tapering – Titration

Titration tapering is a method used for medications that present challenges using the pill cutting method. Medication titration is a method that uses a liquid suspension to create dosing levels that can be calibrated to very small milligram levels. People often choose this method when they are trying to create dosing levels much smaller than what can be achieved by the pill-cutting method. The administration dosing levels are converted from milligram (mg) dosing to milliliter (mL) dosing. There are difficulties to this method when attempting this alone. The best advice here is to use a compounding pharmacy capable of creating a suspension with equal distribution. Challenges with titration tapering include:
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Medication Crossover and Substitution Tapering

Medication crossover and substitution techniques are frequently used at the Alternative to Meds Center in an overall effort to become medication free. Many drugs have a short half-life and can present challenges when trying to taper. The purpose of medication crossover and drug substitution techniques is to get the person onto a similar drug that has potentially easier withdrawal characteristics.
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Direct Tapering

This method involves a tapering or titration directly off of the medication that the person is currently taking. This method can be highly successful, especially when supported by natural alternatives. There is a technique here to understand, and that is the conundrum of interdosing withdrawal. A short half-life drug, like Ativan© or Effexor©, may begin to substantially clear the body in less than 24 hours. So if a person is taking the medication only one time per day, as they reduce the medication, they may experience withdrawal within 24 hours as the drug is metabolized. This alone can create a very roller-coaster-like effect of harsh withdrawal symptoms. It is generally better to spread the dosing times out so that this interdosing phenomenon is lessened. Spreading out the dosing can achieve a similar effect to using a longer half-life drug.

Direct tapering is favored in many cases at Alternative to Meds Center, as the medication being used is one that the participant is familiar with. Direct tapering eliminates the possibility of medication substitution reactions. ATMC will also use substitution tapering or medication crossover when the individual situation warrants it.

Interdosing Withdrawal

Many tapering efforts are complicated by interdosing withdrawal, a rather common phenomenon.

Short half-life drugs (those that are substantially metabolized in less than 24 hours) can initiate this interdosing withdrawal symptomatology. The rationale is this, if someone takes a sleep or anti-anxiety medication like Klonopin at night, by the time they take it again the next night, they may already be experiencing withdrawal. This becomes even more pronounced when a person tries to taper because the medication reduction can amplify the interdosing withdrawal side effects. Spreading the dosing out may in some cases be all that is necessary to alleviate this phenomenon. Eliminating interdosing withdrawal potentials typically makes direct tapering more viable.

Tapering Off Opioids

Tapering off of opioids allows for other modalities we offer, such as the neurotransmitter repair protocols, to take effect. This can allow for a much smoother transition to being no longer dependent on opiates, as well as assist the body in producing its own natural endorphins and enkephalins necessary for pain relief. At times, the individual may be crossed over to a medication like Suboxone temporarily. Suboxone has a longer half-life and is generally considered easier to taper from than shorter-acting opiates like Oxycodone or heroin. We support a person’s long-term goal of being off opiates and opioids, including Suboxone, and in the majority of cases, will then gradually remove the Suboxone to further promote the building up of natural endorphins.

Bridge Medications

While every medication can have its liabilities and potential consequences, some are considered to be less consequential overall than others. For instance, gabapentin or Trileptal may be less prone to addiction and side effects than benzodiazepines. Suboxone may be favorable over full opiates or heroin. Depakote may have fewer side effects than antipsychotics. These bridge medications are generally from a different medication class and are used in an overall effort to facilitate medication withdrawal. At Alternative to Meds Center, if bridge medications are used, they are generally used for short-term to ease withdrawal. At times, there could be highly symptomatic persons who may choose to remain on a well-tolerated bridge medication while they further investigate the underlying causes of the symptoms that they have been experiencing.

Alternative to Meds Center’s stance is much more nuanced than either medications or no medications.

We typically hear from people who tell us that they cannot live with the medication side effects, and also cannot live without the meds. And we understand that for many, it can seem that these are the only two options. But for us, there is a third option: being on less or no medications without the debilitating symptoms. There are a variety of reasons a person may be on medications that have been overlooked. The most commonly overlooked contributors are medical aspects, neurotoxicity, as well as genetic, dietary, and psychosocial factors. By systematically addressing these areas, we can facilitate individual goals for those seeking medication withdrawal and relief from symptoms much more sustainably than medication tapering alone. We encourage you to call us for any further questions that you may have.

for Inpatient Medication Tapering Help