The Hospice Clinician Blog

Discontinuing Drugs in Hospice: Which ones need to be tapered? (Part 1)

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Many hospice clinicians are faced with the task of discontinuing a variety of medications for new admissions to their hospice programs. When a patient enters into a hospice program the goals of care will often change from one of therapeutic-disease modifying medication therapy to one of palliative medicine and comfort care. In order to meet the changing goals, a number of non-palliative, disease modifying and disease preventative types of drugs will be stopped. Clinicians are sometimes not clear on which medications need to be tapered and which ones may be stopped abruptly. Certain medications need to be tapered to reduce the potential for adverse effects such as drug discontinuation syndrome or rebound symptoms from the underlying condition being treated. The need to taper a medication is determined by the specific type of medication, the dosage that the patient is currently receiving, the duration of therapy, and the health condition of the patient. This post will provide some guidance on the types of medications that we need to be concerned about stopping abruptly.

Categories of drugs which may need tapering upon discontinuation include: antiepileptic drugs, antipsychotics, betablockers, opioids, antidepressants, corticosteroids, certain muscle relaxants, and benzodiazepines. Patients on low entry-level doses of these medications usually do not require a taper, however, tapering should be considered for mid-range to high doses of these medications. The longer the hospice patient has been on the drug, the greater the risk for a discontinuation reaction. Discontinuation syndrome risks are generally increased across the board when drug therapy has been in place for 6 months or more. The decision to taper vs. abrupt discontinuation will also be influenced to a great extent by the presence of serious adverse effects to the medication in question. In some cases the severity of medication side effects may be worse than the potential risk of withdrawal or rebound effects associated with abrupt discontinuation. Take a look at the table below for the medications that you should consider tapering. More detailed information about each category will be examined in Part 2 of this blog post, so check back later this week for more information on tapering drugs for hospice patients.