How slowly do you taper a dopamine agonist to prevent dopamine agonist withdrawal syndrome (DAWS)?
Just to add to the discussion above, there are some risk profiles you can consider as reported in Rabinak and Nirenberg, PMID 20065130. Those who developed DAWS had higher dopamine agonist dosage and higher overall levodopa equivalence daily dosage, prolonged exposure to agonists, and lower UPDRS mo...
Currently about to do this, myself, though mainly due to symptomatic orthostatic hypotension complicated by PDD/psychosis.
I'll recommend cutting back a half tablet for one of the doses (probably first) for a week and then a 1/2 tablet for the 2nd dose for a week -- and so on until the med is fully ...
I tailor the taper schedule to the patient, depending on age, duration of therapy and general history of sensitivity to medication changes. Usually, I will reduce the dose weekly. For example, with pramipexole, I will reduce the dose by 0.75mg each week.
I taper extremely slowly reducing dose every two weeks. There is nothing to lose going as slowly as possible.
Agree with all the above. Indeed, like steroids, no one really knows the ideal approach. When withdrawing you may have some DAWS mainly anxiety and a sense of being unwell. Adequate counseling to expect some symptoms and the reason you’re withdrawing therapy is an important start.
Then support them ...