Clinical Pharmacology & Dosing

Tapering

TRAzaltarak Kesme
Also known as:Dose tapering · Weaning · Gradual dose reduction

The gradual, planned reduction of a drug's dose over time before stopping it, to avoid withdrawal symptoms, rebound, disease flare or insufficient endogenous hormone production.

In depth

Tapering lets adaptive changes such as receptor up-regulation, neuroadaptation or suppression of the hypothalamic–pituitary–adrenal axis reverse gradually. It is standard after prolonged use of systemic glucocorticoids, benzodiazepines and Z-drugs, opioids, antidepressants, antiepileptics, beta-blockers, clonidine, gabapentinoids and baclofen.

The rate is individualised to the drug's half-life, the duration of use and the patient's response; proportional (percentage) reductions with smaller steps at lower doses are often better tolerated than equal decrements, and switching to a longer-acting agent (e.g., diazepam for short-acting benzodiazepines) can smooth the process. Symptoms during tapering must be distinguished from relapse of the underlying condition.

Clinical pearl

After more than about 3 weeks of systemic glucocorticoid therapy, abrupt cessation risks adrenal insufficiency; give the patient a clear written tapering schedule.

Example drugs

Prednisolone Diazepam Alprazolam Paroxetine Propranolol Baclofen
TRIn Turkish

Azaltarak Kesme

Bir ilacın kesilmeden önce dozunun zaman içinde planlı ve kademeli olarak azaltılmasıdır; amaç yoksunluk belirtilerini, rebound etkiyi, hastalık alevlenmesini veya yetersiz endojen hormon yapımını önlemektir.

Azaltarak kesme, reseptör up-regülasyonu, nöroadaptasyon veya hipotalamus–hipofiz–adrenal aksının baskılanması gibi adaptif değişikliklerin kademeli olarak geri dönmesini sağlar. Sistemik glukokortikoidler, benzodiazepinler ve Z-ilaçları, opioidler, antidepresanlar, antiepileptikler, beta blokörler, klonidin, gabapentinoidler ve baklofenin uzun süreli kullanımından sonra standart yaklaşımdır.

Azaltma hızı ilacın yarılanma ömrüne, kullanım süresine ve hastanın yanıtına göre bireyselleştirilir; düşük dozlarda daha küçük basamaklarla yapılan oransal (yüzde) azaltmalar eşit miktarlı azaltmalardan genellikle daha iyi tolere edilir ve daha uzun etkili bir ajana geçiş (ör. kısa etkili benzodiazepinlerden diazepama) süreci kolaylaştırabilir. Azaltma sırasındaki belirtiler altta yatan hastalığın nüksünden ayırt edilmelidir.

Sistemik glukokortikoid tedavisi yaklaşık 3 haftadan uzun sürdüyse ani kesilme adrenal yetmezlik riski taşır; hastaya açık, yazılı bir azaltma şeması verilmelidir.

Diğer adları:Doz azaltımı · Kademeli kesme · Dozu azaltarak kesme
Updated 24.09.2026 1 views Educational reference — verify against current sources before clinical use.

Read next

Withdrawal SyndromeYoksunluk Sendromu

A characteristic cluster of signs and symptoms that follows abrupt discontinuation, rapid dose reduction or antagonist reversal of a drug to which the body has adapted during prolonged use.

 Rebound EffectRebound Etkisi

The return of the condition being treated, at an intensity exceeding pre-treatment levels, after a drug is stopped or its dose is rapidly reduced.

 Deprescribingİlaç Azaltma (Deprescribing)

The planned and supervised process of reducing the dose of, or stopping, medicines that may be causing harm or are no longer providing sufficient benefit.

 Dose TitrationDoz Titrasyonu

The stepwise adjustment of a drug's dose, usually upwards, according to therapeutic response and tolerability until the target effect or target dose is reached.

 Receptor Up-RegulationReseptör Up-Regülasyonu

An increase in the number or sensitivity of receptors, typically after prolonged receptor blockade or reduced exposure to the endogenous agonist (e.g. denervation), leading to tissue supersensitivity.

 DRESS SyndromeDRESS Sendromu

A severe, delayed, T-cell-mediated drug hypersensitivity syndrome with fever, extensive rash, lymphadenopathy, haematological abnormalities such as eosinophilia, and internal organ involvement.