Gabapentin Withdrawal Can Cause Nausea and Vomiting
Yes, abruptly stopping gabapentin can cause nausea and vomiting as part of a withdrawal syndrome, and the medication should be tapered gradually rather than discontinued "cold turkey."
Evidence from FDA Drug Labeling
The FDA-approved prescribing information for gabapentin explicitly warns about withdrawal-precipitated adverse events 1. While the label emphasizes withdrawal-precipitated seizures as the primary concern, nausea and vomiting are documented as common adverse reactions that can occur with gabapentin use and discontinuation 1.
Clinical Evidence of Gabapentin Withdrawal Syndrome
Multiple case reports document a distinct gabapentin withdrawal syndrome that includes gastrointestinal symptoms:
Nausea and vomiting are recognized withdrawal symptoms that can develop within 1-2 days after abrupt gabapentin discontinuation 2, 3.
One case report specifically documented a patient who developed restlessness, confusion, and agitation after stopping gabapentin, with symptoms unresponsive to benzodiazepines but completely resolving upon gabapentin reinitiation 3.
Withdrawal symptoms have been reported at doses ranging from 400-8000 mg/day, occurring after as little as 3 weeks to as long as 5 years of treatment 4.
Mechanism and Symptom Profile
The withdrawal syndrome from gabapentin resembles benzodiazepine and alcohol withdrawal, likely due to similar mechanisms of action on GABAergic systems 5. Common withdrawal symptoms include:
- Nausea and vomiting 6, 3
- Agitation and anxiety 4, 3
- Sweating and restlessness 4
- Mental status changes 5
- Insomnia and tremors 2
Critical Clinical Recommendations
Gabapentin should be tapered gradually over weeks to months, not stopped abruptly 7, 5. The tapering approach should follow principles similar to benzodiazepine discontinuation:
- For patients on high doses or long-term therapy, consider reducing by approximately 100 mg per month initially 7.
- As doses decrease below 300 mg, slow the taper to 20-30 mg decrements per month 7.
- For the final 100 mg, consider 5 mg decrements every 1-2 weeks 7.
- The entire taper may require 12-18 months in patients with severe dependence 7.
If withdrawal symptoms develop after accidental discontinuation, the optimal treatment is to restart gabapentin immediately 4, 3. Symptoms typically resolve within 8-24 hours of reinitiation 4, 3.
Common Pitfalls to Avoid
- Do not assume withdrawal symptoms are from another cause (such as alcohol withdrawal or primary psychiatric illness) without considering recent gabapentin discontinuation 3.
- Do not treat gabapentin withdrawal with benzodiazepines alone—while they may help with anxiety, they do not address the underlying withdrawal syndrome 3.
- Do not use a one-week taper—even gradual tapers over 7 days have resulted in severe withdrawal symptoms, particularly in geriatric patients or those on chronic therapy 5.
- Do not underestimate withdrawal risk in patients on "therapeutic" doses—withdrawal has been documented even at relatively modest doses of 1200 mg/day 7.