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How To Taper
THE FDA HAS
published approved guidelines
for tapering off these medications. Those guidelines
are what the authors published a decade ago and this
approach is as effective now as it was in 1999.
If you are taking Cogentin along with an antipsychotic drug,
you need to rotate the drug being reduced. Start by reducing
the antipsychotic, wait
then reduce the Cogentin, wait 14-days and then reduce the
antipsychotic drug again, and repeat this approach back and
forth until off both medications.
Reducing the Medication
Reduce the medication gradually and if side effects begin
that are too severe, go back to the last dosage you were
doing fine with, get stable again and then reduce the
medication again, but this time at a slower reduction
amount. The above can seem too basic
and too easy
to understand for it to be misinterpreted. However,
that is not the case.
– Most of us take the word gradual to me slowly, but there
is a need to give a good example of gradual. Imaging you are
in an airplane that is about to descend for the landing.
What would you like that landing to be like? Would you
prefer to not feel the decent and when the plane touches the
runway you do not even feel the tires touch ground. This is
a landing where I have heard the passengers cheer and thank
the pilot when they get off the plane. This is also the
gradual landing we want for you when reducing your
Gradual when tapering off a medication would be; a slow and
steady decent that does not jar and bump the person reducing
the drug. Gradual would also be a speed of reduction that
would allow the person to still function in life and reduce
to a minimum the chance of withdrawal side effects.
If you agree with the above, this removes the idea of
skipping days of the medication in order to reduce the
dosage and get off the drug. Skipping days or alternating
from a higher dosage to a lower dosage every other day is
not gradual. One only needs to examine the half-life of the
medication to establish that datum. You go in withdrawal
every other day and feel an overdose effect the days you are
going back up on the dosage.
Never Skip Days of the Drug
All drugs in this class come in completely different dosages
and with some being in a time-release the variances are too
vast to list in a book of this type.
We will first take what to do with a non-time release
ONLY REDUCE MEDICATION EVERY 14-DAYS Non-Time Release
If you are taking a non-time release medication,
reduce the medication at the smallest reduction
possible. We understand the “smallest reduction possible” is
an arbitrary and we assure you it will be interpreted
differently by many physicians and pharmacists.
With most medications being different there is no way for us
to describe each one and your physician and pharmacist
should be involved in this process regardless. Some
medications can be compounded into exact and precise
reductions. Compounding is when the pharmacist takes the
medication and grinds it to a powdered form and then
encapsulates to a new dosage. This is the ideal way to
reduce all medications but some cannot be compounded and the
cost can also be out of reach for some individuals.
With your pharmacist, see if purchasing a pill slicer will
work for you. You can also purchase a relatively low cost
digital scale that will measure
Talk with your pharmacist about putting the medication in a
solution for measuring reductions. Some medications dissolve
well and can be crushed and put in water and then you pour
out of a flask the reduction amount.
An experienced pharmacist will be of great value to you
during this process.
Time Release or Extended Release Medication
When it comes to reducing medication that is time release,
the process needs to be a little different with the program.
Sometimes time release medications are also offered in a
non-time release form and it is best to cross-over to the
non-time release form of the drug. Your physician and
pharmacist are the ones to guide you through how to take the
medication. Cross over to the non-time release form of the
medication if that is at all possible. Count the cross-over
as a reduction and do not reduce the medication for 14-days.
DO NOT OPEN THE CAPSULE AND REMOVE THE BALLS.
How to Adjust Supplements During the Taper
If you experience withdrawal side effects every time you
reduce the medication, increase the supplements the day
before you reduce the drug, wait 4 days to ensure there is
no withdrawal and then reduce the supplements back down
Reducing the medication is actually the easy part of the
If you have had difficulty reducing the medication in the
past, compounding the drug for a 5% reduction is advised.
Reduce every 14-days, have success and then try reducing by
5% every 14-days.
If this is your first attempt tapering the medication, start
with a 10% reduction, reduce again in 14-days and repeat at
the 10% reduction two additional times. If successful, you
can try a further increase of reduction, but that is not
advised. If withdrawal side effects begin, go back to the
last dosage you were doing fine with and for the next
reduction, reduce at a more gradual rate.