From the Guidelines
To stop gabapentin, it is recommended to gradually taper the dose over a period of at least 7 days to minimize the risk of withdrawal symptoms, such as seizures, anxiety, and insomnia 1.
Tapering Schedule
Start by reducing the daily dose by 300mg every 3 days, for example, if you are taking 900mg per day, reduce to 600mg per day for 3 days, then to 300mg per day for 3 days, and finally stop. Alternatively, your doctor may recommend a more gradual taper, such as reducing the dose by 100-200mg every 2-3 days 1.
Importance of Medical Supervision
It is essential to work closely with your doctor to determine the best tapering schedule for your individual needs, as the rate of tapering may vary depending on the dose and duration of gabapentin use 1.
Risks of Abrupt Discontinuation
Never stop taking gabapentin abruptly, as this can increase the risk of severe withdrawal symptoms, including seizures, anxiety, and insomnia 1.
Key Considerations
- The tapering schedule should be individualized based on patient goals and concerns 1.
- Longer duration of previous gabapentin therapy might require a longer taper 1.
- Clinically significant withdrawal symptoms can signal the need to further slow the taper rate 1.
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 discontinue gabapentin, it is recommended to do so gradually over a minimum of 1 week, with the possibility of a longer period if deemed necessary by the prescriber.
- The discontinuation should be done under the guidance of a prescriber.
- A gradual taper is advised to minimize potential withdrawal effects. 2
From the Research
Discontinuing Gabapentin
To discontinue gabapentin, a slow taper is recommended to minimize withdrawal symptoms. The following steps can be taken:
- Gradually reduce the daily dose of gabapentin over a period of weeks or months 3, 4
- Use a tapering protocol such as the BRAVO Protocol, which provides a framework for slowly reducing the dose of gabapentin 3
- Reduce the dose by small increments, such as 100 mg per month, until a dose of 300 mg is reached, then slow the taper to 20-30 mg decrements per month 3
- For the last 100 mg, taper down at 5 mg decrements every one to two weeks to 60 mg, at which point gabapentin can be discontinued 3
Withdrawal Symptoms
Gabapentin withdrawal can cause severe physiologic dependence and withdrawal symptoms, including:
- Insomnia and anxiety 5
- Akathisia, characterized by restless limb movements and agitation 6
- Severe mental status changes, somatic chest pain, and hypertension 4
- Flu-like symptoms, such as moderate upper respiratory tract infection symptoms and somatic complaints 4
Tapering Gabapentin
Tapering gabapentin slowly and over a period of weeks or months can help minimize withdrawal symptoms. A gradual taper can be achieved by: