From the Guidelines
Pregabalin should not be discontinued without tapering due to the risk of withdrawal symptoms. When considering discontinuation of pregabalin, it is crucial to prioritize the patient's safety and minimize potential discomfort. According to a high-quality study published in The Lancet Psychiatry in 2019 1, sudden cessation of gabapentinoids, the class of medications to which pregabalin belongs, can lead to physical and psychological withdrawal symptoms.
Key Considerations for Discontinuation
- The decision to stop pregabalin should be made with careful consideration and under the guidance of a healthcare provider.
- A gradual tapering schedule is recommended to reduce the risk of withdrawal symptoms, which can include insomnia, headache, nausea, diarrhea, anxiety, and in some cases, seizures.
- The tapering schedule should be individualized based on the current dose, duration of treatment, and patient-specific factors.
- Patients should be closely monitored during the tapering process to adjust the schedule as needed and provide support to manage any withdrawal symptoms that may arise.
Tapering Schedule
A typical tapering schedule for pregabalin might involve reducing the dose by 50-100 mg every 3-7 days until complete discontinuation, but this should be tailored to the individual patient's needs and response to tapering, as evidenced by clinical guidelines and patient experiences 1.
Importance of Healthcare Provider Guidance
Patients should always consult with their doctor before making any changes to their pregabalin regimen to ensure safety and minimize discomfort during discontinuation. This approach aligns with the recommendation for careful tapering and support when stopping long-term treatment with gabapentinoids, as highlighted in the study published in The Lancet Psychiatry 1.
From the FDA Drug Label
When discontinuing pregabalin, taper gradually over a minimum of 1 week [see WARNINGS AND PRECAUTIONS (5. 6)]. If pregabalin is discontinued, taper the drug gradually over a minimum of 1 week rather than discontinue the drug abruptly.
No, pregabalin (Lyrica) should not be discontinued without tapering. The FDA drug label recommends tapering the drug gradually over a minimum of 1 week to minimize the potential of increased seizure frequency and other symptoms 2.
From the Research
Pregabalin Discontinuation
- Pregabalin discontinuation can lead to withdrawal symptoms, including rebound insomnia and other neurological symptoms 3, 4, 5.
- The severity of withdrawal symptoms can range from mild to moderate and may resolve within one week after discontinuation 4.
- Abrupt discontinuation of pregabalin can cause psychiatric symptoms, such as insomnia and anxiety, even in patients without psychiatric disorders who are taking regular doses of pregabalin 5.
- It is recommended to taper pregabalin doses when reducing or discontinuing treatment to minimize withdrawal symptoms 5, 6, 7.
- Tapering over the course of at least one week is recommended when discontinuing long-term pregabalin therapy 7.
- Pregabalin is classified as a controlled medication, and its discontinuation should be carefully managed to avoid rebound effects or withdrawal symptoms 3, 6.
Tapering Recommendations
- Gradually tapering off pregabalin is necessary to avoid withdrawal symptoms, especially in patients who have been taking the medication for an extended period 6.
- The tapering schedule may vary depending on the individual patient's needs and the duration of pregabalin use 5.
- Close monitoring of withdrawal symptoms during the tapering period is crucial to ensure a safe and effective discontinuation of pregabalin 4, 5.
Withdrawal Symptoms
- Common withdrawal symptoms associated with pregabalin discontinuation include insomnia, anxiety, and rebound insomnia 3, 4, 5.
- Other symptoms may include vegetative symptoms, neurologic and physical complications, and psychopathological symptoms 5.
- The risk of withdrawal symptoms can be minimized by tapering pregabalin doses gradually and monitoring patients closely during the discontinuation period 5, 6, 7.