128 - Tapering in practice

Tapering in practice

122 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 Exponentially reducing regimens (reducing by a fixed proportion of the most recent dose, e.g. 10%) will produce roughly linear reductions at all receptor targets of anti­ psychotics, making it applicable to a wide range of antipsychotic medication. Tapering in practice All patients should be informed of the risk of withdrawal symptoms on stopping or reducing the dose of any antipsychotic, including insomnia and a potential increase in psychotic symptoms. Patients should be warned not to stop antipsychotics abruptly or too quickly, because this is the method thought to be most likely to precipitate a relapse and severe withdrawal effects. Table 1.27  Reductions of olanzapine dose by up to 5 percentage points of D2 occupancy at each step, adjusted to allow use of quarter tablets. Liquid versions of drug will be needed for smaller doses. Period Olanzapine dose (mg) D2 occupancy (%) Period Olanzapine dose (mg) D2 occupancy (%) 20 72.9 4.375 37.5 17.5 70.9 3.75 34.0 15 66.9 3.125 30.4 12.5 62.8 2.5 26.3 10 58.8 2 22.3 8.75 54.7 1.5 17.3 7.5 50.7 1.1 13.1 6.25 46.6 0.7 9.1 5.625 43.5 0.35 4.0 5 40.5 0 Box 1.1  A summary of a slow hyperbolic reduction schedule for olanzapine Reduce olanzapine by 5–10mg every 1–3 months until reaching 20mg per day, then Reduce dose by 2.5–5mg every 1–3 months until reaching 10mg per day, then Reduce dose by 1.25–2.5mg every 1–3 months until reaching 5mg per day, then Reduce dose by 0.6–1.25mg every 1–3 months until reaching 2.5mg per day, then Reduce dose by 0.3–0.6mg every 1–3 months until reaching 1.25mg per day, then Reduce dose by 0.15–0.3mg every 1–3 months until reaching 0.6mg per day, then Reduce dose by 0.07–0.15mg every 1–3 months until olanzapine is completely stopped. This process could take 12–48 months, depending on how the patient tolerates the reductions. Liquid versions of drug or other options will be required for smaller doses.