Tapering Antipsychotic Medications

Introduction to Tapering

The American Academy of Child and Adolescent Psychiatry recommends tapering antipsychotic medications like olanzapine gradually to prevent serious withdrawal symptoms and minimize the risk of relapse 1

A hyperbolic (percentage-based) tapering schedule is recommended, where the dose is reduced by a percentage of the current dose, not the original dose, with a general starting point of reducing by 25% of the most recent dose every 1-2 weeks 1
For patients on olanzapine for more than 1 year, the taper should be extended to 10% per month rather than the faster 25% every 1-2 weeks schedule, as recommended by clinical guidelines 2

The taper rate must be determined by the patient's tolerance to dose reductions, not a rigid schedule, with pauses in the taper acceptable and often necessary when withdrawal symptoms emerge, as suggested by clinical guidelines 2

Patients should follow up with their doctor at least monthly during the taper, with more frequent contact needed during difficult phases, and monitor for return of original symptoms, withdrawal symptoms, mood changes, and suicidal ideation 2
The return of original symptoms, such as psychosis, mania, or depression, may take weeks to months to emerge after dose reduction, and should be monitored closely 1, 3

If a patient is taking both olanzapine and a benzodiazepine, and both need to be discontinued, the benzodiazepine should be tapered first due to higher risks associated with benzodiazepine withdrawal, including seizures, as recommended by clinical guidelines 2
Pregnant patients should not taper olanzapine without specialist consultation, as withdrawal can cause serious complications, and the risk of overdose increases after tapering, as warned by clinical guidelines 2