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Medical: Gradual Dose Reduction Schedule Cheat Sheet by

Reducing Drug Dosages for LTC patients
reduction     medical     snf     healthcare     dug     antispychotics     anxioytes

Introd­uction: Antips­ych­otics & Anxiol­ytics

• During the first year of use of these drugs in the facility, there should be one attempt to reduce the medica­tion.
• If succes­sful, a second (2nd) attempt should be tried in a subsequent quarter of that same year.
• The attempts should be at least a month apart.
• After the first year, the gradual dose reduction should be attempted at least once a year.
• If unsucc­essful, further reductions can be considered “cli­nically contra­ind­ica­ted” (see next box for details).

Clinically contra­ind­icated

Clin­ically contra­ind­icated related to dement­ia: is defined as 2 failed dose reductions attempts in a 12-month period. The reduction attempt resulted in a return or worsening of symptoms after the MOST RECENT attempt WITHIN the facility and the physician documents the clinical rationale.

Clin­ically contra­ind­icated related to psychi­atric disord­er: defined as 2 failed dose reductions attempts in a 12-month period. The continued use is in accordance with relevant current standards of practice and the physician has documented clinical rationale OR the resident’s targeted symptoms returned or worsened after the MOST RECENT attempt WITHIN the facility and the physician has documented clinical rationale.
Exempted Indica­tions for Reduct­ions: Tourette’s Disorder, movement disorders associated with Huntin­gton’s disease, hiccups, nausea and vomiting associated with cancer or chemot­herapy, or adjunctive therapy at end of life

Hypnotics

• Daily use of a hypnotic should not exceed 10 consec­utive days unless an attempt at a gradual dose reduction is unsucc­essful.
• Gradual dose reductions should be attempted quarterly at least 3 times within one year before it can be concluded that a gradual dose reduction is “clini­cally contra­ind­ica­ted”.
Hypn­oti­cs: Drugs used for sleep induction should only be used when all possible reasons for insomnia have been ruled out.
 

Other Psycho­pha­rma­col­ogical Medica­tions

Applicable medica­tions depends on how the medication is used or what condition the medication is used to treat:

Anxi­oly­tics
• Antide­pre­ssants
• Benzod­iaz­epines
• Buspirone

Gradual dose reduction is indicated when these drugs are used to manage behavior, stabilize mood or treat a psychi­atric disorder

Freq­uency of Gradual Dose Reduction:
• Within the first year of use, taper twice in 2 separate quarters with at least one month between attempts.
• After the first year, once annually.
F329 Federal Survey tag states that diphen­hyd­ramine and hydrox­yzine are not approp­riate for use as anxiol­ytics

Exempted Gradual Dose Reduction Indica­tions

Exempted Gradual Dose Reduction Indica­tions
• Used for neurom­uscular syndromes such as cerebral palsy, tardive dyskin­esia, restless leg syndrome or seizure disorders.
• Long-a­cting benzod­iaz­epines used to withdraw a resident from short-­acting benzod­iaz­epines.
• Symptom relief in end of life situat­ions.
Tapering is clinically contra­ind­icated if:
• The continued use is in accordance with relevant current standards of practice AND the physician has documented clinical rationale.
• The resident’s targeted symptoms returned or worsened after the MOST RECENT tapering attempt WITHIN the facility AND the physician has documented clinical rationale.

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