Pregabalin Tapering Protocol
When discontinuing pregabalin, taper gradually over a minimum of 1 week to minimize withdrawal symptoms. 1
Recommended Tapering Schedule
The optimal tapering schedule for pregabalin depends on the current dose, duration of treatment, and patient-specific factors. Here is a structured approach:
Standard Tapering Protocol
- Initial taper: Reduce dose by 50-100 mg/day each week 2
- For patients on higher doses (≥300 mg/day):
- Week 1: Reduce by 25% of original dose
- Week 2: Reduce by another 25% of original dose
- Week 3: Reduce by another 25% of original dose
- Week 4: Discontinue remaining dose
Slower Tapering for High-Risk Patients
For patients who have been on pregabalin for longer durations (e.g., years) or who have a history of withdrawal symptoms:
- Consider a slower taper of 10% per month rather than 10% per week 2
- This more gradual approach may be better tolerated in long-term users
Monitoring During Tapering
Monitor for withdrawal symptoms during the taper, which may include:
- Drug craving
- Anxiety
- Insomnia
- Abdominal pain
- Vomiting
- Diarrhea
- Diaphoresis
- Tremor
- Tachycardia 2
Special Considerations
- Pause if necessary: Tapers may need to be paused and restarted when the patient is ready 2
- Slow at lower doses: The taper may need to be slowed once patients reach low dosages 2
- Success criteria: A taper is considered successful as long as the patient is making progress 2
- Final discontinuation: Once the smallest available dose is reached (25 mg), the interval between doses can be extended before complete discontinuation 2
Important Cautions
- Avoid abrupt discontinuation: This can lead to withdrawal symptoms similar to those seen with benzodiazepines 3
- Risk of seizures: In patients taking pregabalin for epilepsy, abrupt discontinuation may increase seizure frequency 4
- Pregnancy considerations: Consult appropriate expertise if tapering during pregnancy due to potential risks to both the pregnant patient and fetus 2
- Overdose risk: Discuss with patients the increased risk of overdose if they abruptly return to a previously prescribed higher dose after tapering 2
Adjunctive Support During Tapering
- Consider cognitive behavioral therapy (CBT) to increase tapering success rates, particularly for patients struggling with the taper 2
- For patients experiencing anxiety during the taper, evidence-based psychotherapies or specific non-benzodiazepine medications approved for anxiety may be beneficial 2
Remember that while these guidelines provide a framework, the taper may need to be individualized based on patient response, with the primary goal being to minimize withdrawal symptoms while successfully discontinuing the medication.