What is the recommended tapering schedule for gabapentin (Neurontin)?

Recommended Tapering Schedule for Gabapentin (Neurontin)

Gabapentin should be tapered gradually over a minimum of 1 week, with a recommended approach of reducing the dose by 10-25% every 1-7 days to minimize withdrawal symptoms. 1

Standard Tapering Protocol

• Begin with a 10-25% reduction of the previous dose every 1-7 days 2
• For patients on higher doses or long-term therapy, consider slower tapers (e.g., 10% reduction per month) 3
• Monitor for withdrawal symptoms after each dose reduction before proceeding to the next step 2

Tapering Strategy Based on Daily Dose

• For patients on 1800 mg/day or less:

  • Reduce by 300 mg every 3-7 days 4, 1
  • Example: 1800 mg → 1500 mg → 1200 mg → 900 mg → 600 mg → 300 mg → discontinue 4

• For patients on doses higher than 1800 mg/day:

  • Initial reduction to 1800 mg/day 4
  • Then follow the standard tapering protocol 4, 1

• For patients with severe dependence:

  • Consider slower tapers of approximately 100 mg per month until reaching 300 mg 3
  • For the final 300 mg, reduce by 20-30 mg per month 3
  • For the last 100 mg, consider even smaller decrements (5 mg every 1-2 weeks) 3

Managing Withdrawal Symptoms

• Common withdrawal symptoms include:

  • Anxiety, insomnia, irritability, and restlessness 5
  • Akathisia (inner restlessness with repetitive movements) 5
  • Flu-like symptoms 6
  • Mental status changes and hypertension 6

• If withdrawal symptoms occur:

  • Return to the previous well-tolerated dose 2
  • Slow the taper further 3
  • In severe cases, restart gabapentin at the original dose and initiate a more gradual taper 5

Special Considerations

• Patients with renal impairment require dose adjustments based on creatinine clearance 1
• Elderly patients are more likely to have decreased renal function and may require more careful dose selection 1
• Patients who have been on gabapentin for years may require much slower tapers than those on short-term therapy 3, 6

Common Pitfalls to Avoid

• Abrupt discontinuation can lead to severe withdrawal symptoms even after just one month of treatment 5
• Tapering too quickly may precipitate withdrawal symptoms similar to those of benzodiazepine withdrawal 6
• Even with a gradual taper over one week, withdrawal symptoms can still occur, especially in geriatric patients or those on long-term therapy 6
• Never abandon patients during the tapering process; ensure continued monitoring and support 3