Treatment guidelines for the use of tapering strips

Tapering Strips are a means by which patients can gradually and steadily reduce their dosage of certain psychotropic medications. This approach reduces or eliminates many of the common withdrawal symptoms that are experienced when a psychotropic medication is abruptly stopped or the dosage reduced too quickly.
Additionally, the use of Tapering Strips puts control of withdrawal in the hands of the patient and they, together with their medical professional, can use shared decision making to design the best approach to withdrawal or dosage reduction.

How to use this guideline

This guideline is provided to help doctors and patients together assess the suitability of Tapering Strips as a means to gradually reduce medication dosage. This brief explanation provides an overview of the process. More detailed, supporting information is provided later in the document.

Brief summary of the steps to take

STEP 1
Firstly, review the following list, if one or more of the following statements are true, the use of Tapering Strips is suggested as the next step:

Has the patient experienced:
• Withdrawal symptoms and/or rebound effects suspected to have been caused by a fast reduction or abrupt discontinuation of their psychotropic medication.
• Anxiety or worry about having to stop or reduce their medication (e.g. in the case of patients who also have an anxiety disorder).
• One of more prior failed attempts to reduce or stop their medication.
• Symptoms that are different to those that the patient originally required the medication for (for example, the patient originally reported low mood, but now reports nausea and dizziness)
• Use of the medication for 6 months or longer, at a dose of at least 150% of the daily recommended dose.

STEP 2
Next, consult the list of the medications that can can be tapered using Tapering Strips. If the relevant Tapering Strip is available, proceed to step 3.

STEP 3
Treatment guidelines for the use of tapering strips – URC Maastricht University
Determine the starting dosage (usually the same dosage that the patient is currently taking).
Determine the time taken to reduce. This will vary by patient and the doctor and patient together will need to take account of many factors, for example:
• The pace of reduction at which the patient feels comfortable.
• If the patient has to work or has other responsibilities such as caring for children.
• If other medications are also being taken.
• If there are any other health issues present that may interfere with the withdrawal process.
• Other factors that either the doctor or patient may feel are applicable.

STEP 4
Select the combination of Tapering Strips that will achieve the gradual reduction agreed between the patient and the doctor in Step 3.
Provide simple written instructions that are agreed with the patient and that the patient feels confident they can follow.
Provide the patient with a Tapering Strip monitoring form (to be created) that will provide the basis of regular discussions on progress and how the patient feels about the process.

STEP 5
Arrange regular (at least monthly) review sessions to discuss the tapering process. If an adjustment or a pause in the tapering is necessary, it can be discussed by the patient and the doctor and agreed here.
At the end of the tapering period, we would be grateful if the patient and doctor would complete the Tapering Strip evaluation form (to be created) for our research and future improvement work.

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