Clinical Titration Calculator & Consultation Handout
Generate an individualized, step-wise deprescribing regimen based on the Ashton Protocol or Horowitz & Taylor Hyperbolic Deprescribing guidelines. Formatted for direct integration into medical appointments.
PATIENT-DIRECTED CLINICAL DEPRESCRIBING PROTOCOL
Prepared via mhrx.org Clinical Formulary • Harm-Reduction Deprescribing
Target: Outpatient Physician Chart Integration
Titration Regimen
MEASURED RECEPTOR DISENGAGEMENT SCHEDULE
| # | Target Date | Prescribed Dose | Step Cut | Cumulative | Dispensing Formulation | Protocol Notes |
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Clinical Directives for the Prescribing Physician
1. Pharmacokinetic Basis: Conventional linear cuts cause steep collapses in receptor occupancy at lower doses due to hyperbolic (Michaelis-Menten) binding curves. Proportional reductions of the most recent dose (Horowitz & Taylor, Lancet Psychiatry 2019) ensure smooth receptor disengagement and prevent severe neuroadaptive shock.
2. Formulation Directives: When dosage steps fall below commercial tablet division thresholds, please support the patient by prescribing commercial oral liquid solution (e.g. Sertraline 20mg/mL, Escitalopram 1mg/mL, Diazepam 2mg/5mL) or transmitting an individualized script to an accredited compounding pharmacy.
3. Patient-Directed Hold Criteria: Maintain each dosage step for a minimum of 2 to 4 weeks until withdrawal symptoms have stabilized before proceeding. If acute withdrawal emerges, pause the taper; do not enforce rigid calendar decrements.
4. Citations: Horowitz MA, Taylor D. Lancet Psychiatry 2019; 6(6): 538–546 • Taylor D, Horowitz MA. The Maudsley Deprescribing Guidelines, Wiley 2024 • NICE Guideline NG215 (2022).