What is the recommended tapering schedule to discontinue gabapentin (Neurontin) 300 mg three times a day (TID)?

Gabapentin Tapering from 300 mg TID (900 mg/day)

For gabapentin 300 mg TID (900 mg/day total), reduce by 100 mg every 2-3 days for a rapid 1-week taper, or use a slower 10% per week reduction (approximately 100 mg weekly) if the patient has been on gabapentin for months to years or has concerns about withdrawal symptoms. 1, 2, 3

Recommended Tapering Schedules

Rapid Taper (1 Week) - For Short-Term Use

For patients who have been on gabapentin for shorter durations (weeks to a few months), a rapid taper is appropriate:

• Days 1-2: Reduce to 800 mg/day (300 mg + 300 mg + 200 mg)
• Days 3-5: Reduce to 600 mg/day (300 mg twice daily)
• Days 6-7: Reduce to 300 mg/day (single dose)
• Day 8: Discontinue completely 2

Standard Taper (9-10 Weeks) - For Long-Term Use

For patients on gabapentin for months to years, a 10% per week reduction of the original dose is recommended:

• Weeks 1-3: Reduce by 100 mg weekly (900 mg → 800 mg → 700 mg → 600 mg)
• Weeks 4-6: Continue 100 mg weekly reductions (600 mg → 500 mg → 400 mg → 300 mg)
• Weeks 7-9: Reduce by 100 mg weekly (300 mg → 200 mg → 100 mg)
• Week 10: Discontinue 1, 3

The FDA label specifically states that gabapentin should be discontinued "gradually over a minimum of 1 week," though longer periods may be needed at the prescriber's discretion. 3

Very Slow Taper - For High-Risk Patients

For elderly patients, those with severe comorbidities, or patients who develop withdrawal symptoms with standard tapering:

• Consider 50 mg reductions every 1-2 weeks 2
• Once below 300 mg, consider even smaller decrements (20-30 mg per month) 4
• For the final 100 mg, reductions of 5 mg every 1-2 weeks may be necessary 4
• This approach may require several months to complete 1, 4

Monitoring for Withdrawal Symptoms

Assess at each dose reduction for the following withdrawal symptoms:

• Drug craving, anxiety, insomnia
• Abdominal pain, vomiting, diarrhea
• Diaphoresis (sweating), tremor, tachycardia
• Agitation, restlessness, akathisia (inner restlessness with motor movements)
• Sleep disturbances
• Pain exacerbation (if gabapentin was used for neuropathic pain) 1, 2, 5

If severe withdrawal symptoms occur, return to the previous dose and slow the taper rate. 1 Withdrawal symptoms can develop after as little as 1 month of gabapentin use and have been reported at doses ranging from 400-8000 mg/day. 5

Managing Withdrawal Symptoms

Non-Pharmacological Approaches

• Cognitive behavioral therapy
• Relaxation techniques
• Physical activity 1

Pharmacological Adjuvants

If withdrawal symptoms are problematic despite slowing the taper, consider:

• Gabapentin itself: The optimal treatment for gabapentin withdrawal is to restart gabapentin at the previous dose and taper more slowly 5
• For anxiety/insomnia: Trazodone, mirtazapine, or gabapentin 100-300 mg TID (if using for withdrawal from other medications) 6

Critical Pitfalls to Avoid

• Never abruptly discontinue gabapentin - withdrawal symptoms can be severe and include akathisia, agitation, and mental status changes even after tapers as short as 1 week in some patients 5, 7
• Do not assume a 1-week taper is sufficient for all patients - the FDA's "minimum of 1 week" guidance may be inadequate for patients on long-term therapy 3, 7
• Do not use ultrarapid detoxification approaches - these are associated with substantial risks 1
• Warn patients about the increased risk if they abruptly return to their previous dose after successful tapering 1
• Do not confuse withdrawal symptoms with relapse of the original condition - withdrawal can occur even when gabapentin was not effectively treating the underlying condition 1

Special Populations

Elderly Patients

• Start with slower tapers (50 mg reductions every 1-2 weeks)
• Monitor more closely for falls related to dizziness during taper 2

Pregnant Patients

• Require specialist consultation due to potential risks to both mother and fetus if withdrawal occurs 1

Patients with Renal Impairment

• No specific taper adjustments are outlined in guidelines, but these patients may have altered gabapentin clearance and require closer monitoring 3

Follow-Up Schedule

Monitor patients at least monthly during the taper process, with more frequent contact (weekly or bi-weekly) as needed for patients experiencing withdrawal symptoms or those at higher risk. 1 Consider pausing the taper and restarting when the patient is ready if withdrawal symptoms become intolerable. 1