Question from a Member: Was wondering whether gabapentin has to be tapered off slowly?
Definitely. Gabapentin must be tapered off.
Potential symptoms of gabapentin withdrawal
If the patient stops gabapentin abruptly, withdrawal symptoms can occur.
The symptoms are generally similar to those of benzodiazepine withdrawal. The most frequent ones are anxiety, insomnia, nausea, pain, and sweating. But symptoms vary a lot. Confusion, disorientation, tremor, tachycardia, and hypertension can occur.
A case of akathisia has been reported (e.g., See et al., 2011). This is consistent with case reports of using gabapentin to treat akathisia (Pfeffer et al., 2005; Sullivan and Wilbur, 2014).
There are many published reports of severe symptoms, including delirium, delirium tremens, and seizures that occurred after gabapentin was stopped (e.g., Tran et al., 2005; Pittenger and Desan, 2007; Hellwig et al., 2010).
So, gabapentin MUST be tapered in all cases and not stopped abruptly. This issue should be taken very seriously because the withdrawal can be severe.
Who is at risk of gabapentin withdrawal?
Withdrawal symptoms have been reported in patients who had been on as little as gabapentin 400 mg/day or had been on gabapentin for only one month.
When does it occur?
Most commonly, the withdrawal symptoms appear within one or two days, but sometimes the onset can be delayed for up to seven days (Mersfelder and Nichols, 2015).
It is very important to remember that gabapentin withdrawal does not respond to treatment with benzodiazepines (Mersfelder and Nichols, 2015; Hellwig et al., 2010).
Instead, gabapentin should be restarted. It works well in removing the withdrawal symptoms. Then, it can be tapered slowly over many weeks.
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