Yes, you should taper off 150 mg daily of Lyrica (pregabalin) rather than stopping abruptly.
While the FDA label does not explicitly mandate tapering for pregabalin discontinuation, clinical evidence demonstrates that withdrawal symptoms can occur even at standard therapeutic doses like 150 mg/day, making a gradual taper the safest approach.
Why Tapering is Necessary
Pregabalin withdrawal is a documented phenomenon that occurs even in patients taking regular prescribed doses without any history of abuse or dependence. Multiple case reports demonstrate that abrupt discontinuation of pregabalin at doses as low as 150 mg/day can trigger withdrawal symptoms 1, 2, 3, 4. These symptoms can include:
- Psychiatric symptoms: Insomnia, anxiety, agitation
- Neurologic complications: Seizures (documented even at 150 mg/day) 3
- Vegetative symptoms: Sweating, palpitations
- Physical symptoms: Headache, dizziness
Importantly, withdrawal can occur after relatively short treatment durations—as brief as 2 months—and does not require prolonged use 1.
Recommended Tapering Approach
While guidelines emphasize careful titration when starting pregabalin 5, the same cautious approach should be applied in reverse when discontinuing:
Practical tapering schedule for 150 mg/day:
- Reduce to 75 mg/day for 1 week
- Then reduce to 50 mg/day for 3-4 days
- Then reduce to 25 mg/day for 3-4 days
- Then discontinue
This mirrors the titration increments recommended in guidelines (increasing by 150 mg/day every 3-7 days) 5, applied in reverse with smaller decrements.
Important Caveats
Monitor closely for withdrawal symptoms during the taper, including:
- New or worsening anxiety or insomnia
- Seizure activity (particularly concerning if you have renal impairment) 3
- Rebound of original pain symptoms
If you have renal impairment, you may be at higher risk for withdrawal complications and may require an even slower taper, as pregabalin accumulates more in reduced kidney function 6.
Duration of use matters: If you've been on pregabalin for only a few weeks, a faster taper over 1-2 weeks may suffice. If you've been on it for months to years, consider a slower taper over 2-4 weeks 1.
The evidence clearly shows that even "low" therapeutic doses like 150 mg/day carry withdrawal risk 1, 2, 4, making abrupt discontinuation inadvisable. The clinical principle of "start low, go slow" for pregabalin initiation 5 should equally apply to discontinuation—"taper slow, monitor close."