Transitioning from Gabapentin to Pregabalin (Lyrica)
Do not abruptly stop gabapentin when starting pregabalin. You should continue your morning dose of gabapentin while beginning Lyrica, then gradually taper off gabapentin over several days to weeks to avoid withdrawal symptoms. 1, 2
Recommended Transition Plan
- Start pregabalin 75 mg twice daily while continuing your morning dose of gabapentin for at least the first few days 1, 3
- After 3-7 days, if you're tolerating pregabalin well, begin gradually reducing your gabapentin dose by 100-300 mg every 1-7 days 1, 4
- Continue this gradual reduction until gabapentin is completely discontinued 5
- Monitor for withdrawal symptoms during the transition (restlessness, agitation, anxiety, insomnia) 6
Rationale for Gradual Transition
- Abrupt discontinuation of gabapentin can cause withdrawal symptoms including restlessness, agitation, anxiety, insomnia, and in some cases akathisia (severe restlessness) 4, 6
- Both medications work on the same calcium channel α2δ subunit, but pregabalin has more predictable absorption and linear pharmacokinetics compared to gabapentin 3
- A gradual transition allows your body to adjust to the new medication while preventing withdrawal 7
Dosing Considerations
- Pregabalin's starting dose of 75 mg twice daily is appropriate when transitioning from gabapentin 3
- The maximum recommended dose of pregabalin is 600 mg per day, divided into two or three doses 1, 3
- Pregabalin can be taken with or without food 2
- Common side effects of both medications include dizziness and somnolence, which may be reduced by gradual titration 1
Important Warnings
- Never stop either medication abruptly as this can lead to withdrawal symptoms that may include anxiety, insomnia, nausea, pain, and sweating 2, 8
- Some patients require very slow tapering of gabapentin, sometimes taking several months for complete discontinuation in cases of severe dependence 7
- Both medications can cause dizziness and somnolence; avoid driving or operating machinery until you know how these medications affect you 2, 8
- Do not drink alcohol while taking either medication as this can increase side effects such as dizziness and sleepiness 2
Special Considerations
- If you experience withdrawal symptoms during the transition, your healthcare provider may need to slow the taper or temporarily increase the gabapentin dose 6
- For elderly patients or those with renal impairment, lower doses and slower titration may be necessary 1, 3
- Both medications require dosage adjustments in patients with renal insufficiency 1