What is the recommended tapering schedule for discontinuing 900 mg of gabapentin (Neurontin)?

Gabapentin Tapering Schedule for 900 mg Daily Dose

For discontinuing 900 mg of gabapentin, reduce the dose by 50 mg every 7 days over approximately 18 weeks to minimize withdrawal symptoms and ensure patient safety. 1

Rationale for Gradual Tapering

Gabapentin withdrawal can cause significant symptoms even with a taper, particularly in patients who have been on the medication for extended periods. A case report demonstrated that even with a one-week taper, a patient developed severe withdrawal symptoms including respiratory symptoms, somatic complaints, mental status changes, and hypertension 2.

Recommended Tapering Schedule for 900 mg Daily Dose

Based on the most recent guidelines, the following tapering schedule is recommended:

• Weeks 1-2: Reduce from 900 mg to 850 mg daily
• Weeks 3-4: Reduce to 800 mg daily
• Weeks 5-6: Reduce to 750 mg daily
• Weeks 7-8: Reduce to 700 mg daily
• Weeks 9-10: Reduce to 650 mg daily
• Weeks 11-12: Reduce to 600 mg daily
• Weeks 13-14: Reduce to 500 mg daily
• Weeks 15-16: Reduce to 400 mg daily
• Week 17: Reduce to 300 mg daily
• Week 18: Reduce to 200 mg daily, then 100 mg daily, then discontinue

This schedule follows the recommendation of reducing by approximately 50 mg per week for doses under 300 mg/day 1. For the final week, the reductions can be slightly faster as the dose is very low.

Dosing Considerations

• Maintain the same dosing frequency during tapering (typically three times daily for gabapentin) 3
• The maximum time between doses should not exceed 12 hours to maintain stable blood levels 3
• If the patient is elderly or has renal impairment, consider an even more gradual taper (5% reduction every 2-4 weeks) 1

Managing Withdrawal Symptoms

Common withdrawal symptoms may include:

• Anxiety and irritability
• Insomnia
• Headaches
• Nausea
• Sweating
• Pain
• Seizures (in rare cases)

If withdrawal symptoms become severe during tapering, consider:

1. Temporarily returning to the previous dose
2. Stabilizing at that dose for 2-4 weeks
3. Attempting a slower taper (reducing by 25-50 mg every 2 weeks)

Adjunctive Treatments for Withdrawal Symptoms

The following medications may help manage specific withdrawal symptoms:

• Hydroxyzine for anxiety and agitation
• Trazodone for insomnia
• Acetaminophen for pain (not exceeding 3000 mg daily) 1

Special Considerations

• Renal impairment: For patients with compromised renal function (creatinine clearance <60 mL/min), the tapering schedule should be adjusted based on the FDA guidelines for dosage adjustment 3
• Elderly patients: Should undergo a more gradual tapering schedule (5% reduction every 2 weeks) 1
• Seizure history: Patients with a history of seizures require particularly careful monitoring during the taper

Conclusion

A slow, methodical taper over approximately 18 weeks provides the safest approach to discontinuing gabapentin at a 900 mg daily dose. This approach minimizes the risk of withdrawal symptoms while safely discontinuing the medication.