What is the fastest tapering schedule for discontinuing 300mg of gabapentin (Neurontin) in an inpatient setting?

Gabapentin Tapering Protocol for Inpatient Discontinuation of 300mg Dose

The fastest and safest way to taper off 300mg gabapentin in an inpatient setting is to reduce the dose by 100mg every 2-3 days, with complete discontinuation achievable within one week. 1

Recommended Tapering Schedule

• Day 1-2: Reduce from 300mg daily to 200mg daily 1
• Day 3-5: Reduce to 100mg daily 1
• Day 6-7: Discontinue completely 1, 2

Rationale for Tapering

• Abrupt discontinuation of gabapentin, even at lower doses like 300mg, can lead to withdrawal symptoms similar to those seen with benzodiazepines 2, 3
• Withdrawal symptoms can occur after as little as 3-4 weeks of gabapentin use 3
• Documented withdrawal symptoms include:
  • Restlessness and akathisia (inner feeling of restlessness with repetitive movements) 3
  • Anxiety and agitation 2
  • Upper respiratory symptoms and somatic complaints 2
  • Mental status changes 2

Monitoring During Tapering

• Assess for withdrawal symptoms daily during the taper, including:
  • Vital sign changes, particularly blood pressure elevations 2
  • New onset restlessness or agitation 3
  • Sleep disturbances 1
  • Pain exacerbation, particularly if gabapentin was used for neuropathic pain 4

Special Considerations for Inpatient Setting

• The inpatient setting allows for faster tapering than would be recommended in outpatient settings due to continuous monitoring capabilities 5
• If withdrawal symptoms emerge during tapering:
  • Temporarily return to the previous dose 3
  • Resume tapering at a slower rate (e.g., extend each step to 3-4 days) 2
• For patients with severe comorbidities or the elderly, consider an even more gradual taper with smaller decrements (e.g., 50mg reductions) 1, 2

Important Caveats

• While this represents the fastest safe taper, some patients may require a more gradual approach 2
• Even with a taper, some patients may still experience withdrawal symptoms 2
• Patients with a history of seizures require special caution, as gabapentin withdrawal can potentially lower seizure threshold 6
• If the patient has been taking gabapentin for longer than 3 months, consider extending the taper to 2 weeks 1, 2

This tapering protocol balances the need for rapid discontinuation in the inpatient setting while minimizing the risk of withdrawal symptoms, which can be uncomfortable and potentially dangerous if not properly managed.