From the Guidelines
To taper pregabalin from 200mg four times a day to 200mg three times a day, I recommend a gradual decrease in dosage over 1-2 weeks, starting by reducing the fourth dose to 100mg for 3-4 days before eliminating it completely, as suggested by the pharmacokinetic properties of pregabalin 1. When considering the tapering of pregabalin, it's essential to prioritize minimizing potential withdrawal symptoms such as anxiety, insomnia, headaches, or nausea that can occur with sudden reduction.
- The recommended approach involves:
- Starting with the regular 200mg dose in the morning, afternoon, and evening
- Reducing the fourth dose to 100mg for 3-4 days
- Then eliminating the fourth dose completely while maintaining the three 200mg doses
- This gradual tapering helps maintain stable blood levels, with consistent timing between the three remaining doses (approximately every 8 hours) 1.
- It's crucial to consult a healthcare provider before making this change, as they may recommend a different tapering schedule based on the patient's specific medical condition and history.
- The goal of this tapering schedule is to reduce the total daily pregabalin intake from 800mg to 600mg, which is within the recommended maximum dosage of 600 mg/d (200 mg 3 times daily) for pregabalin, as indicated in the study 1.
From the Research
Tapering Pregabalin
To taper pregabalin from 200mg four times a day to 200mg three times a day, consider the following steps:
- Reduce the dose gradually to minimize withdrawal symptoms, as discontinuation symptoms can be mild to moderate and resolve in about one week after discontinuation 2.
- Monitor the patient closely for withdrawal symptoms during the taper period, as cautious monitoring is crucial 2.
- Consider a 'low and slow' dosing approach to limit common side effects and optimize tolerability, and initiate 'asymmetric dosing' with the larger dose in the evening when requiring titration to higher doses 3.
- Be aware of the potential for pregabalin misuse and associated withdrawal risks, including delirium, especially in patients with no psychiatric or substance use history 4.
Considerations
- Pregabalin has a similar pharmacological profile to gabapentin but has greater analgesic activity in rodent models of neuropathic pain 5.
- Gabapentin may not be a suitable substitution therapy for pregabalin use disorder, as it may not reduce pregabalin withdrawal and craving 6.
- General practitioners should closely monitor patients and up-titrate according to pain relief and side effects to limit suboptimal dosing or premature discontinuation 3.