From the FDA Drug Label
If the gabapentin dose is reduced, discontinued, or substituted with an alternative medication, this should be done gradually over a minimum of 1 week (a longer period may be needed at the discretion of the prescriber). The recommended tapering schedule for decreasing the dose of Gabapentin (Neurontin) is to do it gradually over a minimum of 1 week. A longer period may be needed at the discretion of the prescriber. 1
From the Research
When decreasing gabapentin, a gradual tapering schedule is recommended to avoid withdrawal symptoms, with the most recent and highest quality study suggesting a tapering process that can take up to 18 months, starting with a reduction of 100 mg per month until reaching 300 mg, then slowing to 20-30 mg decrements per month, and finally tapering down by 5 mg every one to two weeks for the last 100 mg 2. The tapering schedule should be individualized based on the patient's response and the presence of withdrawal symptoms. Some key points to consider when tapering gabapentin include:
- Starting with a daily dose reduction of 100 mg per month until reaching 300 mg, as seen in the case report of a patient with gabapentin dependence and withdrawal 2
- Slowing the taper to 20-30 mg decrements per month after reaching 300 mg, as this can help minimize the risk of withdrawal symptoms
- Tapering down by 5 mg every one to two weeks for the last 100 mg, as this can help prevent rebound symptoms
- Monitoring the patient closely for signs of withdrawal, such as anxiety, insomnia, headache, and nausea, and adjusting the tapering schedule as needed
- Considering the use of the BRAVO Protocol, which provides a framework for a patient-centered, slow taper of gabapentin 2 It's essential to consult with a healthcare provider before changing the medication regimen, as individual factors may require personalized adjustments to the tapering approach. The evidence from the studies suggests that gabapentin can be an effective treatment for various conditions, including epilepsy and neuropathic pain, but the tapering schedule should be carefully managed to minimize the risk of withdrawal symptoms and ensure the best possible outcome for the patient. In terms of the specific tapering schedule, the most recent and highest quality study suggests a more gradual approach, with a tapering process that can take up to 18 months 2. This approach is supported by the case report of a patient with gabapentin dependence and withdrawal, which highlights the importance of a patient-centered, slow taper of gabapentin 2. Overall, the key to a successful tapering schedule is to individualize the approach based on the patient's response and to monitor closely for signs of withdrawal, adjusting the schedule as needed to minimize the risk of adverse effects.