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How To Wean Off Acetaminophen?
Question: I have been trying to withdraw from acetaminophen after inadvertently becoming dependent on it over the past few months due to stress headaches. I have been slowly reducing the amount I take each few days, but then reached a point where the symptoms increased and I went back up a notch in dosage and got relief. Any suggestions you could make would be appreciated, including how long this process generally takes if one doesn't go cold turkey, which I'm afraid would be too much for me to handle.
Brief Answer:
Please see details below.
Detailed Answer:
Dear XXXXXXX
I went through your query in detail and do appreciate the fact the you want to get rid of acetaminophen. I completely understand when you say that this a frustrating experience.
First of all, regarding acetaminophen. It generally doesn't cause any physiological dependence and more likely causes a psychological dependence. It definitely causes a rebound increase in pain symptoms when you try to stop it, if you have been taking it for a very long period of time.
I would have liked to know the exact symptoms for which you started acetaminophen, duration for which you are taking it and the current dose.
I certainly agree with your doctor about going slow and tapering it with a small dose only at a time. That makes us minimize the withdrawal effects. Depending on the total dose, it may even take a few weeks. I would generally recommend to decrease 1/10th of the dose every 3-4 days. The only disadvantage is that it takes more time with this process.
In addition, it is necessary to take care of the underlying condition that you are suffering from and make sure it is adequately managed. That will help us tapering the medicine even faster.
Going cold turkey, or at a much faster speed will cause rebound symptoms and it will be necessary to add some another agent to take care of the rebound. It might help in getting rid of acetaminophen immediately but, then will take some time to get rid of the substituting drug.
I will want you to remember one thing while reducing the dose. Most of the dependence is psychological. So, keep yourself motivated and I know you can do it. in addition, try doing some amount of exercise regularly which can help you relax.
I do hope that I was able to answer your query. Please feel free to ask any further question that you might have.
Wish you all the very best and happy quitting,
Dr. Sunil Gupta
Please see details below.
Detailed Answer:
Dear XXXXXXX
I went through your query in detail and do appreciate the fact the you want to get rid of acetaminophen. I completely understand when you say that this a frustrating experience.
First of all, regarding acetaminophen. It generally doesn't cause any physiological dependence and more likely causes a psychological dependence. It definitely causes a rebound increase in pain symptoms when you try to stop it, if you have been taking it for a very long period of time.
I would have liked to know the exact symptoms for which you started acetaminophen, duration for which you are taking it and the current dose.
I certainly agree with your doctor about going slow and tapering it with a small dose only at a time. That makes us minimize the withdrawal effects. Depending on the total dose, it may even take a few weeks. I would generally recommend to decrease 1/10th of the dose every 3-4 days. The only disadvantage is that it takes more time with this process.
In addition, it is necessary to take care of the underlying condition that you are suffering from and make sure it is adequately managed. That will help us tapering the medicine even faster.
Going cold turkey, or at a much faster speed will cause rebound symptoms and it will be necessary to add some another agent to take care of the rebound. It might help in getting rid of acetaminophen immediately but, then will take some time to get rid of the substituting drug.
I will want you to remember one thing while reducing the dose. Most of the dependence is psychological. So, keep yourself motivated and I know you can do it. in addition, try doing some amount of exercise regularly which can help you relax.
I do hope that I was able to answer your query. Please feel free to ask any further question that you might have.
Wish you all the very best and happy quitting,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. XXXXXXX
I really appreciate your response, which has given me a better idea of what to expect, as well as some relief in knowing that this is not a physiological dependency.
I began taking acetaminophen daily a few months ago, during a rather stressful period. I had some health issues, as well as some others, that I felt nervous about, or that caused me some pain; and I had an underlying worry about an upcoming endoscopy, because prior ones had shown pre-cancers that had to be removed, and the question now was whether there were more or I was clear of it. After each stressful situation was resolved, I expected the headaches to go away, but when they didn't, I kept using acetaminophen, not realizing the danger (my bottle said nothing about limiting days, only dose, which I followed). Finally, the endoscopy (my fifth in a little over a year) was fine (just another follow-up needed in two years, but still headache. Finally, I suspected that something else was at work, including the possibility of something bad. At last I checked in with my doctor, and he determined that it was analgesic rebound and nothing more. That was at the beginning of this month, and I have been slowly reducing the dose since then, every three to five days. The last one was 750 mg in the AM, 125 in the afternoon, 250 in the evening. That's when I started to feel worse again, so I returned (with my doctor's OK) to the last time I felt all right, two turns ago (500, 250, 250). He's having me do this for five to seven days.
I like your idea of making the reductions smaller (1/10th), in the hopes that the reaction would be less severe. I'll pursue that with my doctor, as I'm quite willing to go slow as long as I am assured of the rightness of this path.
Thanks again for the reassurance re: the psychological emphasis, as I know that's helped in the past, and I feel best when I worry least and focus on the positive things in my life, of which there are a great many.
If you have any other advice, I'd appreciate it. I have been focusing more and more, throughout this process, on staying with the positive, and I will recommit to continuing that.
Thanks again, very much.
XXXX
I really appreciate your response, which has given me a better idea of what to expect, as well as some relief in knowing that this is not a physiological dependency.
I began taking acetaminophen daily a few months ago, during a rather stressful period. I had some health issues, as well as some others, that I felt nervous about, or that caused me some pain; and I had an underlying worry about an upcoming endoscopy, because prior ones had shown pre-cancers that had to be removed, and the question now was whether there were more or I was clear of it. After each stressful situation was resolved, I expected the headaches to go away, but when they didn't, I kept using acetaminophen, not realizing the danger (my bottle said nothing about limiting days, only dose, which I followed). Finally, the endoscopy (my fifth in a little over a year) was fine (just another follow-up needed in two years, but still headache. Finally, I suspected that something else was at work, including the possibility of something bad. At last I checked in with my doctor, and he determined that it was analgesic rebound and nothing more. That was at the beginning of this month, and I have been slowly reducing the dose since then, every three to five days. The last one was 750 mg in the AM, 125 in the afternoon, 250 in the evening. That's when I started to feel worse again, so I returned (with my doctor's OK) to the last time I felt all right, two turns ago (500, 250, 250). He's having me do this for five to seven days.
I like your idea of making the reductions smaller (1/10th), in the hopes that the reaction would be less severe. I'll pursue that with my doctor, as I'm quite willing to go slow as long as I am assured of the rightness of this path.
Thanks again for the reassurance re: the psychological emphasis, as I know that's helped in the past, and I feel best when I worry least and focus on the positive things in my life, of which there are a great many.
If you have any other advice, I'd appreciate it. I have been focusing more and more, throughout this process, on staying with the positive, and I will recommit to continuing that.
Thanks again, very much.
XXXX
One other question, Dr. Gupta: How can I measure my dose so that I'm able to reduce it by 1/10th? I don't have a scale that fine, and am at a bit of a loss about this, though I think it's a very good idea.
Thanks.
Thanks.
Brief Answer:
You are on right track... best wishes
Detailed Answer:
Dear XXXXXXX
Thanks for following up and many more thanks for your kind words. I am glad that you found my reply helpful.
I was nice to know that you have been taking acetaminophen only for a few months and your dose is also not considerably very high. With a current total of 1000 mg/day, I think you will be able to do it soon enough. You are doing in a correct way. If on reduction of dose, you have any symptoms, try relaxing yourself first. If it doesn't work, then think about increasing the dose.
I could make out from your response that you tend to worry and get stressed. So, I would recommend you start doing some sort of relaxation training like deep breathing or meditation which will help you feel better and also help in overcoming the rebound symptoms of withdrawal. Another thing that actually works, is discussing your problems and letting out your emotions. Generally, it can be done with someone close or a therapist. Another alternative is to write a diary on a daily basis. It helps in relaxing.
I really liked it when you said that you have had many positive experiences. It goes on to show your optimism and I am now confident, you are going to get over this phase real soon.
I do hope I was able to help you in some way. Please don't hesitate in asking any further queries that you might have, now or in future. If you have none, you can close this discussion and please rate the answer.
Happy quitting,
Dr. Sunil Gupta
You are on right track... best wishes
Detailed Answer:
Dear XXXXXXX
Thanks for following up and many more thanks for your kind words. I am glad that you found my reply helpful.
I was nice to know that you have been taking acetaminophen only for a few months and your dose is also not considerably very high. With a current total of 1000 mg/day, I think you will be able to do it soon enough. You are doing in a correct way. If on reduction of dose, you have any symptoms, try relaxing yourself first. If it doesn't work, then think about increasing the dose.
I could make out from your response that you tend to worry and get stressed. So, I would recommend you start doing some sort of relaxation training like deep breathing or meditation which will help you feel better and also help in overcoming the rebound symptoms of withdrawal. Another thing that actually works, is discussing your problems and letting out your emotions. Generally, it can be done with someone close or a therapist. Another alternative is to write a diary on a daily basis. It helps in relaxing.
I really liked it when you said that you have had many positive experiences. It goes on to show your optimism and I am now confident, you are going to get over this phase real soon.
I do hope I was able to help you in some way. Please don't hesitate in asking any further queries that you might have, now or in future. If you have none, you can close this discussion and please rate the answer.
Happy quitting,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. XXXXXXX
You're right, I do tend to worry and get stressed, but I have also done a number of things to counter it, including some meditation and breathing, and do at least one walk a day of at least 30 minutes and listen to music. I also think about things I'm grateful for -- a great many, as I wrote. I think I will try writing a diary too (something I used to do). Thanks for these suggestions. Now, my biggest challenge is not worrying about getting over this, silly I know, but challenging for me because of the headaches. I'm doing my best, which was quite good until this setback, so I'll keep refocusing on the positive. I know sharing more would be good, besides with my husband, who is sympathetic, but I don't want to burden him with it. I looked for online or local support groups, but couldn't find anything.
Meanwhile, I did have one question you didn't respond to: what do I need to get to be able to measure milligrams, so I can do those small reductions?
Again, thank you very much. This is definitely very helpful to me.
XXXX
You're right, I do tend to worry and get stressed, but I have also done a number of things to counter it, including some meditation and breathing, and do at least one walk a day of at least 30 minutes and listen to music. I also think about things I'm grateful for -- a great many, as I wrote. I think I will try writing a diary too (something I used to do). Thanks for these suggestions. Now, my biggest challenge is not worrying about getting over this, silly I know, but challenging for me because of the headaches. I'm doing my best, which was quite good until this setback, so I'll keep refocusing on the positive. I know sharing more would be good, besides with my husband, who is sympathetic, but I don't want to burden him with it. I looked for online or local support groups, but couldn't find anything.
Meanwhile, I did have one question you didn't respond to: what do I need to get to be able to measure milligrams, so I can do those small reductions?
Again, thank you very much. This is definitely very helpful to me.
XXXX
Brief Answer:
Please see details below
Detailed Answer:
Dear XXXXXXX
Thanks for following up. First of all let me apologize for not answering your question then. I had already started replying to the first response and after I sent the reply, saw your second question. And since I had already answered, I was not able to answer to the next question. Somehow, this website doesn't allow that. So, I was waiting for you to respond so that I could reply. I am really sorry for it.
When I said 1/10th of the dose, it doesn't have to be exact 1/10th. It can be the nearest possible dosing that you can get. For example, If you are taking 100 mg/day, 1/10th would be 100 mg. But you can bring it to 125 mg as that dosing will be easier to take due to the available preparations. I am sorry, I caused confusion. For initial two steps, you can educe it by 125 mg. Thereafter you can make it 62.5 mg. That will make it easier for the dose to be adjusted.
When we want the dose to be exact 10 %, (not necessary in your case), we advise it the whole dose to be mixed in a fixed amount of water. For example, a 1000 mg dose can be mixed in 100 ml of water and then discard 10 ml of the preparation. That makes it exact 90% of the dose remaining. It is usually required only when adhering to a fixed dose in necessary and in drugs that cause physiological dependence and drugs which easily dissolve in water. I don't think, it is necessary in you case.
I do appreciate that you have been doing quite a bit for relaxation. You seem to know everything and I am sure soon you will be able to get over this little situation of yours. I don't think your husband will feel burdened with you sharing your feelings with him. It generally makes a bong stronger. Anyway, that is one decision you have to take on your own. You can also directly contact me anytime you feel like you want to share anything. I will try my best to help you in the best possible way.
Thanks again for your appreciation. Please let me know if I can be of further help to you.
Best wishes,
Dr. Sunil Gupta
Please see details below
Detailed Answer:
Dear XXXXXXX
Thanks for following up. First of all let me apologize for not answering your question then. I had already started replying to the first response and after I sent the reply, saw your second question. And since I had already answered, I was not able to answer to the next question. Somehow, this website doesn't allow that. So, I was waiting for you to respond so that I could reply. I am really sorry for it.
When I said 1/10th of the dose, it doesn't have to be exact 1/10th. It can be the nearest possible dosing that you can get. For example, If you are taking 100 mg/day, 1/10th would be 100 mg. But you can bring it to 125 mg as that dosing will be easier to take due to the available preparations. I am sorry, I caused confusion. For initial two steps, you can educe it by 125 mg. Thereafter you can make it 62.5 mg. That will make it easier for the dose to be adjusted.
When we want the dose to be exact 10 %, (not necessary in your case), we advise it the whole dose to be mixed in a fixed amount of water. For example, a 1000 mg dose can be mixed in 100 ml of water and then discard 10 ml of the preparation. That makes it exact 90% of the dose remaining. It is usually required only when adhering to a fixed dose in necessary and in drugs that cause physiological dependence and drugs which easily dissolve in water. I don't think, it is necessary in you case.
I do appreciate that you have been doing quite a bit for relaxation. You seem to know everything and I am sure soon you will be able to get over this little situation of yours. I don't think your husband will feel burdened with you sharing your feelings with him. It generally makes a bong stronger. Anyway, that is one decision you have to take on your own. You can also directly contact me anytime you feel like you want to share anything. I will try my best to help you in the best possible way.
Thanks again for your appreciation. Please let me know if I can be of further help to you.
Best wishes,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. XXXXXXX
I so appreciate your responses, which are thoughtful, compassionate, and complete -- and, again, very helpful. Now I understand exactly about the dose and am sure I can do that. And you're right about my husband, who's terrific. Besides, I'm not someone who can help but share with him what I'm thinking about and feeling. Fortunately, he doesn't seem to mind, and even does the same with me, if not as obsessively. But I greatly appreciate your advice, and feel you give me a different and fuller perspective than I otherwise get, though I like my doctor very much.
One thing I just want to confirm: you said that if I've lowered my dose but then am having problems, I can first try relaxing but if that doesn't work can up the dose a bit. Is that likely to make me more dependent upon the drug, or do you think I'll be able to handle the shifts? I think I will but am uncertain, as this whole thing is a new experience for me, and certainly one I hope not to repeat.
When I'm on stronger ground, I'd like to ask you some questions about after, how to deal with headache or other pain (sometimes neck or back) without getting "hooked" again. But that can wait.
Once more, thank you so much.
XXXX
I so appreciate your responses, which are thoughtful, compassionate, and complete -- and, again, very helpful. Now I understand exactly about the dose and am sure I can do that. And you're right about my husband, who's terrific. Besides, I'm not someone who can help but share with him what I'm thinking about and feeling. Fortunately, he doesn't seem to mind, and even does the same with me, if not as obsessively. But I greatly appreciate your advice, and feel you give me a different and fuller perspective than I otherwise get, though I like my doctor very much.
One thing I just want to confirm: you said that if I've lowered my dose but then am having problems, I can first try relaxing but if that doesn't work can up the dose a bit. Is that likely to make me more dependent upon the drug, or do you think I'll be able to handle the shifts? I think I will but am uncertain, as this whole thing is a new experience for me, and certainly one I hope not to repeat.
When I'm on stronger ground, I'd like to ask you some questions about after, how to deal with headache or other pain (sometimes neck or back) without getting "hooked" again. But that can wait.
Once more, thank you so much.
XXXX
Brief Answer:
Just be confident, you can do it.
Detailed Answer:
Dear XXXXXXX
Thank you would not be enough for your kind words for me. It is appreciation from people like you which makes me go on and feel proud of myself.
I am so glad to know about your husband and more importantly, you feel so wonderful about him. Having a great life partner makes life easy, isn't it? Moreover, your husband is also lucky to have an adorable wife as you who loves him so much.
I am pretty sure you will be able to handle the dose reduction. Uncertainty in such conditions is normal. So, you don't need to worry about it. Increasing dose will only be for a short period and that too only if you are having too much pain. Thereafter, you will reduce the dose again after a few days. That will only make the whole process a bit longer. But then, i won't worry much about time here. Your stopping of the drug should be smooth without causing you much trouble and that's the first target.
I will look forward to your queries and will try my best to help you out. You can contact me on my directly at:
http://doctor.healthcaremagic.com/doctors/dr-sunil-gupta/67657
Thanks once again for your kind words of appreciation. If you don't have any further query for now, please don't forget to close the discussion and rate the answer.
Regards,
Dr. Sunil Gupta
Just be confident, you can do it.
Detailed Answer:
Dear XXXXXXX
Thank you would not be enough for your kind words for me. It is appreciation from people like you which makes me go on and feel proud of myself.
I am so glad to know about your husband and more importantly, you feel so wonderful about him. Having a great life partner makes life easy, isn't it? Moreover, your husband is also lucky to have an adorable wife as you who loves him so much.
I am pretty sure you will be able to handle the dose reduction. Uncertainty in such conditions is normal. So, you don't need to worry about it. Increasing dose will only be for a short period and that too only if you are having too much pain. Thereafter, you will reduce the dose again after a few days. That will only make the whole process a bit longer. But then, i won't worry much about time here. Your stopping of the drug should be smooth without causing you much trouble and that's the first target.
I will look forward to your queries and will try my best to help you out. You can contact me on my directly at:
http://doctor.healthcaremagic.com/doctors/dr-sunil-gupta/67657
Thanks once again for your kind words of appreciation. If you don't have any further query for now, please don't forget to close the discussion and rate the answer.
Regards,
Dr. Sunil Gupta
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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