How to discontinue Lyrica (pregabalin)

How to Discontinue Lyrica (Pregabalin)

Pregabalin should be tapered gradually over a minimum of 1 week rather than discontinued abruptly to minimize withdrawal symptoms and prevent increased seizure risk. 1

Understanding Pregabalin Withdrawal

Pregabalin discontinuation can lead to several withdrawal symptoms when stopped suddenly:

• Insomnia, nausea, headache, anxiety, hyperhidrosis (excessive sweating), and diarrhea can occur following abrupt or rapid discontinuation 1
• Psychiatric symptoms such as anxiety and insomnia can develop even in patients without psychiatric disorders who were taking regular doses 2
• Physical dependence is an expected response for patients treated with medications like pregabalin over an extended period 3

Recommended Tapering Approach

General Tapering Guidelines

• Gradual tapering is essential to minimize discontinuation effects and withdrawal symptoms 3
• Taper rate should be determined by the patient's ability to tolerate it 3
• Consider implementing very small dose decreases at first to address patient anxiety and increase confidence in the process 3
• Each new dose should be 90% of the previous dose rather than using a straight-line taper 3

Specific Tapering Schedule

• Minimum tapering period: 1 week as recommended in the FDA drug label 1
• For patients on higher doses or longer-term therapy, consider a more extended taper of 2-4 weeks 3
• For patients experiencing withdrawal symptoms during taper, slow the taper further and consider extending over several weeks 3

Monitoring During Discontinuation

• Monitor for withdrawal symptoms throughout the tapering process 3
• Be prepared to pause the taper or slow the rate if withdrawal symptoms emerge 3
• Close observation and support during the taper are critical, as is clinician availability to treat symptoms and manage fears 3

Special Considerations

Patients with Seizure Disorders

• Patients with seizure disorders require extra caution as pregabalin withdrawal may increase seizure frequency 1
• Consider an even more gradual taper in these patients to minimize seizure risk 1

Patients Taking Multiple Medications

• If a patient is taking pregabalin with other CNS depressants (especially opioids or benzodiazepines), consider tapering pregabalin first 3
• When tapering multiple medications, generally taper the medication with the most side effects or least benefit first 3

Adjunctive Treatments

• Consider non-pharmacological approaches to manage symptoms during tapering:
  • Cognitive behavioral therapy may be helpful for managing anxiety during the taper 3
  • Exercise and physical activity may help reduce withdrawal symptoms 3

Common Pitfalls to Avoid

• Avoid abrupt discontinuation which significantly increases withdrawal risk 1, 2
• Do not confuse withdrawal symptoms with return of the original condition being treated 4
• Avoid setting unrealistic expectations about the speed of discontinuation 5
• Remember that withdrawal symptoms can occur even after relatively short treatment periods (as little as 2 months) 2

When to Seek Additional Help

• If severe withdrawal symptoms occur despite gradual tapering, consider re-escalating the dose temporarily before attempting a slower taper 3
• For patients with complex medical conditions or those experiencing significant difficulty with tapering, consider referral to a specialist 3