From the Guidelines
Pregabalin withdrawal syndrome is a significant concern in geriatric patients, and a gradual tapering approach is crucial to minimize the risk of withdrawal symptoms and related morbidity and mortality. When considering the discontinuation of pregabalin in older adults, it is essential to prioritize a careful and gradual tapering strategy to avoid abrupt cessation, which can lead to severe withdrawal symptoms 1. The tapering schedule may involve reducing the dose by 50-75mg per week, with slower reductions for lower doses. Geriatric patients are more susceptible to withdrawal symptoms, including insomnia, headache, nausea, diarrhea, anxiety, and in severe cases, seizures, due to age-related factors such as altered pharmacokinetics and reduced renal clearance 1.
Key Considerations for Tapering Pregabalin in Geriatric Patients
- Gradual tapering over several weeks to months is recommended
- Typical tapering schedules involve reducing the dose by 50-75mg per week
- Slower reductions for lower doses may be necessary
- Close monitoring of patients during tapering is crucial to adjust the schedule based on individual response
- Temporary symptomatic management of withdrawal symptoms may be necessary
- Non-pharmacological approaches, such as proper hydration, sleep hygiene, and emotional support, are essential to manage the withdrawal process
Healthcare providers should be aware of the potential complications associated with pregabalin withdrawal in geriatric patients, including comorbidities and polypharmacy, which can further exacerbate withdrawal symptoms 1. By prioritizing a gradual tapering approach and close monitoring, healthcare providers can minimize the risk of morbidity and mortality associated with pregabalin withdrawal syndrome in this vulnerable population.
From the Research
Pregabalin Withdrawal Syndrome in Geriatric Patients
- Pregabalin is used to treat various conditions, including neuropathic pain, partial seizures, and generalized anxiety disorder 2.
- The discontinuation symptoms of pregabalin can be mild to moderate and typically resolve within one week after discontinuation 2.
- However, a case report describes a 62-year-old patient who experienced withdrawal symptoms despite a slow titration over several weeks, highlighting the importance of cautious monitoring during tapering 2.
Pregabalin Withdrawal Symptoms
- Pregabalin withdrawal can cause psychiatric symptoms, such as insomnia and anxiety, even in patients without psychiatric disorders who are taking regular doses 3.
- A systematic review of six case reports found that pregabalin withdrawal can occur with regular doses and short-term use, resulting in psychopathological symptoms, vegetative symptoms, and neurologic and physical complications 3.
- Another study reported that patients experiencing pregabalin withdrawal mainly had psychiatric problems, nervous system symptoms, general disorders, and gastrointestinal symptoms 4.
Management of Pregabalin Withdrawal
- The management of pregabalin use disorder is challenging due to the risks associated with abrupt withdrawal and the lack of guidelines 4.
- Strategies for managing pregabalin withdrawal include hospitalization, gradual dose reduction, and adjuvant medications 4.
- Pregabalin has been used as an adjunctive treatment for benzodiazepine withdrawal, with a success rate of 52% in a 12-week study 5.
- A comprehensive review suggests that pregabalin may be a potential treatment for physical dependence and associated withdrawal symptoms, but more research is needed to confirm its efficacy and safety 6.