Pregabalin Dose Reduction Protocol
When discontinuing pregabalin, taper gradually over a minimum of 1 week to avoid withdrawal symptoms, with a recommended reduction of approximately 25-33% of the total daily dose per week. 1, 2
Standard Tapering Schedule
For a patient on 300 mg/day (100 mg three times daily), follow this weekly reduction protocol:
- Week 1: Reduce to 225 mg/day (75 mg three times daily) 2
- Week 2: Reduce to 150 mg/day (50 mg three times daily) 2
- Week 3: Reduce to 75 mg/day (25 mg three times daily) 2
- Week 4: Discontinue 2
For patients on 600 mg/day, use the same proportional reduction strategy, decreasing by approximately 150 mg/week. 1
Critical Factors Requiring Slower Tapering
Extend each tapering step to 2 weeks instead of 1 week if:
- Withdrawal symptoms emerge (headache, nausea, dizziness, insomnia, anxiety) 2
- Patient is elderly or has significant comorbidities 1, 2
- Patient has renal impairment (pregabalin is 95% renally excreted unchanged) 1, 3
- Patient has been on pregabalin for >6 months at high doses 1
- Pain symptoms return or worsen during tapering 2
Monitoring During Dose Reduction
Watch for these specific withdrawal symptoms:
- Headache, nausea, dizziness (most common) 2
- Insomnia and anxiety 4
- Return or worsening of original pain condition 2
- Increased seizure risk in patients with epilepsy (do not abruptly discontinue) 5
Monitor elderly patients more closely for confusion, balance disorders, tremor, and fall risk, as they are more susceptible to adverse effects during dose changes. 1, 2
Common Pitfalls to Avoid
Do not abruptly discontinue pregabalin - this increases risk of withdrawal symptoms and seizures in susceptible patients. 1, 5
Do not use a rigid one-size-fits-all approach - some patients require individualized tapering schedules based on clinical response, particularly those with longer treatment duration or higher baseline doses. 2
Do not ignore emerging withdrawal symptoms - if symptoms occur, slow the taper immediately by extending each step or reducing the magnitude of dose decrements. 2
Do not assume faster tapering is always better - while the minimum recommended taper is 1 week, many patients benefit from 3-4 weeks or longer, especially elderly patients or those with renal impairment. 1, 2