From the FDA Drug Label
If the gabapentin dose is reduced, discontinued, or substituted with an alternative medication, this should be done gradually over a minimum of 1 week (a longer period may be needed at the discretion of the prescriber). To wean gabapentin when taking 300mg twice a day, the dose should be reduced gradually over a minimum of 1 week. The prescriber may need to extend this period based on their discretion.
- Key considerations:
- Reduce the dose gradually
- Minimum duration for reduction: 1 week
- The prescriber may extend the duration as needed 1
From the Research
To wean off gabapentin when taking 300mg twice daily, I recommend a gradual tapering schedule over several months, with a reduction of 100mg per month until reaching 300mg, then slowing to 20-30mg decrements per month, and finally tapering down at 5mg decrements every one to two weeks to minimize withdrawal symptoms, as suggested by the BRAVO Protocol 2. When considering the tapering process, it's essential to prioritize the patient's safety and comfort, as gabapentin withdrawal can lead to severe symptoms, including anxiety, insomnia, headaches, nausea, and in rare cases, seizures.
- The tapering schedule should be individualized, taking into account the patient's medical history, current medications, and potential risk factors for withdrawal symptoms.
- The BRAVO Protocol, initially developed for opioids and adapted for benzodiazepines, provides a framework for a patient-centered tapering approach, which can be applied to gabapentin tapering 2.
- Studies have shown that a gradual tapering schedule can minimize withdrawal symptoms, and the BRAVO Protocol offers a practical and compassionate strategy for tapering gabapentin 2.
- It's crucial to consult with a healthcare provider before beginning the tapering process, as they may recommend a different schedule based on the patient's specific medical situation.
- If severe withdrawal symptoms occur during the taper, the patient should contact their doctor immediately, as the tapering schedule may need adjustment. Some studies have reported cases of gabapentin withdrawal symptoms, including anxiety, insomnia, and seizures, even with a gradual tapering schedule 3, 4, 5, 6. However, the most recent and highest-quality study suggests that a slow and gradual tapering schedule, such as the one outlined in the BRAVO Protocol, can minimize these symptoms and ensure a safe and comfortable tapering process 2.