Pregabalin Withdrawal Can Cause Seizures in Elderly Patients
Yes, abrupt discontinuation of pregabalin can cause seizures in an 80-year-old male, and pregabalin should be tapered gradually rather than stopped suddenly to prevent withdrawal symptoms including seizures. 1
Mechanism and Risk Factors
Pregabalin, like other gabapentinoids, works on the central nervous system through binding to voltage-gated calcium channels, affecting neurotransmitter release. When discontinued abruptly, this can lead to:
- Neuronal hyperexcitability
- Disruption of GABA-mediated inhibition
- Increased seizure risk, especially in elderly patients
Elderly patients (80 years old) are at particularly high risk due to:
- Age-related changes in drug metabolism
- Potential comorbidities affecting drug clearance
- Increased neuronal vulnerability
Evidence of Seizure Risk
The FDA drug label for pregabalin specifically warns that abrupt or rapid discontinuation can increase seizure frequency in patients with seizure disorders 1. Following abrupt discontinuation, patients may experience:
- Insomnia
- Nausea
- Headache
- Anxiety
- Hyperhidrosis
- Diarrhea
- Seizures
Case reports document serious withdrawal symptoms even in patients taking regular prescribed doses of pregabalin 2. A particularly relevant case involved an 80-year-old man who developed multifocal negative myoclonus and confusion after starting pregabalin, demonstrating the neurological vulnerability in this age group 3.
Another case report documented status epilepticus following abrupt discontinuation of gabapentin (a similar medication to pregabalin) in a patient with no previous seizure history 4, highlighting the potential severity of gabapentinoid withdrawal.
Proper Discontinuation Protocol
To prevent withdrawal symptoms including seizures:
- Taper pregabalin gradually over a minimum of 1 week rather than discontinuing abruptly 1
- For elderly patients or those on long-term therapy, a more conservative approach is recommended:
- Reduce dose by 25% weekly over 4-6 weeks 5
- Monitor closely for withdrawal symptoms
- Slow the taper if significant withdrawal symptoms emerge
Monitoring During Tapering
During the tapering process, monitor for:
- Early withdrawal symptoms: anxiety, insomnia, nausea
- Neurological symptoms: tremors, myoclonus
- Signs of seizure activity
- Autonomic symptoms: sweating, tachycardia, hypertension
Management of Withdrawal
If withdrawal symptoms occur during tapering:
- Temporarily return to the previous stable dose
- Resume tapering with smaller incremental reductions
- Consider adjunctive medications if needed:
- Benzodiazepines may be used temporarily for severe withdrawal symptoms 5
- Anticonvulsants may be considered for seizure prophylaxis in high-risk patients
Conclusion
Elderly patients are particularly vulnerable to pregabalin withdrawal effects, including seizures. The risk is significant enough that the FDA specifically warns against abrupt discontinuation 1. Always taper pregabalin gradually in elderly patients, with even more caution than in younger adults, to prevent potentially life-threatening withdrawal seizures.