How to taper off pregabalin when taking 100 mg three times a day?

How to Taper Off Pregabalin 100 mg TID

When discontinuing pregabalin at a dose of 100 mg three times daily, taper gradually over a minimum of 1 week to avoid withdrawal symptoms. 1

Recommended Tapering Schedule

• Pregabalin should never be stopped abruptly due to risk of withdrawal symptoms, which can include insomnia, nausea, headache, anxiety, and in rare cases, seizures 1, 2
• The FDA drug label specifically states to "taper gradually over a minimum of 1 week" when discontinuing pregabalin 1
• For patients on 100 mg three times daily (300 mg/day total), consider the following tapering schedule:

Week 1:

• Reduce to 75 mg three times daily (225 mg/day) 3, 1

Week 2:

• Reduce to 50 mg three times daily (150 mg/day) 3, 1

Week 3:

• Reduce to 25 mg three times daily (75 mg/day) 3, 1

Week 4:

• Discontinue completely 1

Factors Affecting Tapering Speed

• Duration of treatment: Longer treatment periods may require slower tapering 2, 4
• Individual sensitivity: Some patients may require more gradual tapering, especially those with:
  • History of seizure disorders 1
  • History of substance abuse (pregabalin has abuse potential) 2, 5
  • Elderly patients or those with renal impairment 3

Monitoring During Tapering

• Watch for withdrawal symptoms during the tapering process, which may include 2:
  • Insomnia
  • Headache
  • Nausea
  • Anxiety
  • Dizziness
  • Return or worsening of pain 4

Special Considerations

• If withdrawal symptoms occur during tapering, consider slowing the taper by extending each step to 2 weeks instead of 1 week 3, 1
• For patients with renal impairment, the tapering schedule may need to be adjusted as pregabalin is primarily eliminated by renal excretion (98%) 6
• Patients with a history of substance abuse may require more careful monitoring during the tapering process, as pregabalin has been associated with abuse and dependence 2, 5

Common Pitfalls to Avoid

• Stopping too quickly: Never discontinue pregabalin abruptly, as this can lead to withdrawal symptoms 1
• Ignoring breakthrough symptoms: If pain or original symptoms return during tapering, consult healthcare provider before adjusting the schedule 4
• One-size-fits-all approach: Some patients may require a more individualized tapering schedule based on their clinical response 3
• Overlooking drug interactions: Be aware of other medications that might interact with pregabalin during the tapering process 6

Remember that pregabalin has linear pharmacokinetics with a mean elimination half-life of 6.3 hours, which makes a gradual tapering approach particularly important to prevent withdrawal symptoms 7, 6.